CD3G gene defects in familial autoimmune thyroiditis

The patients with CD3γ deficiency can present with different clinical findings despite having the same homozygous mutation. We report three new CD3gamma-deficient siblings from a consanguineous family with a combined T-B+NK+ immunodeficiency and their variable clinical and cellular phenotypes despite the same homozygous mutation of the CD3G gene (c.80-1G>C). We also re-evaluate a previously reported non-consanguineous family with two CD3gamma-deficient siblings with the same mutation. The median age at diagnosis was 11 years (14 months-20 years). We found all five patients to display autoimmunity: autoimmune thyroiditis (n = 5), autoimmune haemolytic anaemia (n = 2), immune thrombocytopenia (n = 1), autoimmune hepatitis (n = 1), minimal change nephrotic syndrome (n = 1), vitiligo (n = 1) and positive antinuclear antibodies (n = 3) as well as high IgE (n = 2) and atopic eczema (n = 2). While CD3(+) TCRαβ+T cell percentages were low in all patients, only one had lymphopenia and 3 had CD3(+) T cell lymphopenia. Strikingly, we report frequent and multiple autoimmunity in tested heterozygous carriers in both families (n = 6; in 67%), and frequent autoimmunity in family members not available for testing (n = 5, in 80%). The results suggest that CD3G should be studied as a candidate gene for autoimmunity and that CD3gamma deficiency should be considered among other primary immunodeficiencies with predominantly autoimmune manifestations.

The role of ace gene polymorphism in the development of angioedema secondary to angiotensin converting enzyme inhibitors and angiotensin II receptor blockers

BACKGROUND

Angiotensin Converting Enzyme inhibitors (ACEi) may cause angioedema, with an incidence of 0.1 % to 1 %, which may be life-threatening. ACEi induce angioedema by increasing the levels of bradykinin. Angiotensin II receptor blockers (ATRB), have a pharmacological profile similar to ACEi. The polymorphism of the ACE gene is based on the presence or absence of a 287-bp element on intron 16 on chromosome 17. The plasma level of ACE is related to gene polymorphism. ACE level in genotype DD is double that in genotype II.

OBJECTIVE

The aim of this study was to investigate whether the relationship between ACE gene polymorphism and ACEi induced angioedema is present or not.

METHODS

ACE gene polymorphism was investigated in patients with angioedema due to the use of ACEi or ATRB (n:32, group 1), in patients receiving ACEi or ATRB without angioedema (n:46, group 2), and healthy controls (n:96, group 3).

RESULTS

ID polymorphism was the most frequent genotype in all groups, without any significant difference among the groups (p:0.868). ACE gene polymorphism was not related with the drugs used (ACEi or ATRB), localisation of angioedema, and female sex, in group 1.

CONCLUSION

Our results showed that ACE gene polymorphism has no effect on ACEi or ATRB induced angioedema.

Is allergenic similarity predictable in respiratory allergies?

BACKGROUND

First degree relatives of patients with allergic diseases are at increased risk of having the disorder. However, it is not clear whether two such related patients with allergic diseases are sensitive to the same antigens or not.

OBJECTIVE

The aim of this study to determine whether or not first degree relatives with respiratory allergies are more likely to be skin test positive to the same allergen extracts as unrelated patients.

PATIENTS AND METHODS

Skin test results for 35 common aeroallergens were compared in 264 pairs of genetically related subjects and 264 pairs of age and sex matched, but unrelated, subjects. We calculate the percentages of the concordant and discordant results in each group. Results are compared by using chi2 test.

RESULTS

For all related and unrelated groups combined, there were significant differences with mites (der. pteronyssinus, der. farinae) and some moulds (aspergillus mix and rhizopus nigricans) (p<0.05); When the groups were subdivided into parent-child pairs and same or different sibling pairs, and the same comparisons were made, a significant difference was only found in both sibling pairs (p<0.05), not in parent-child pairs (p>0.05). Since there was no both positivity with aspergillus mix and rhizopus nigricans in the two groups, these two allergens were excluded from the study.

CONCLUSION

It is concluded that we could not say that if one or both of parents are atopic to any allergens, their child will be atopic to the same allergens. Besides, when a respiratory allergy occurs in siblings, only the one who has house dust mite allergy sensitivity can possess the similar antigen sensitivity.

Not all ACE inhibitor related angioedema is always evident: a case which is misdiagnosed as panic attack and speech disorder

Angiotensin-converting enzyme (ACE) inhibitors are the most common medications responsible for angioedema. Angioedema is a potentially life threatening conditions especially in geriatric age patients that they have take a several medications include ACE inhibitors and non steroidal anti inflammatory drugs. We present a case an ACE inhibitor induced angioedema that confused many clinical events.

Serum leptin levels and lipid profiles in patients with allergic rhinitis and mild asthma

BACKGROUND

Despite improved understanding of the pathophysiology of allergic rhinitis and asthma, the effect of serum leptin level is still controversial. Only a few studies have been performed to investigate the serum leptin levels in allergic rhinitis and asthma, and contradictory results have been observed.

OBJECTIVE

We aimed to investigate the association between leptin, lipid profiles and allergic rhinitis and mild asthma, and to determine whether inhaled and/or intranasal steroids affect the leptin levels.

PATIENTS AND METHODS

We studied 43 patients with allergic rhinitis (10 of with mild asthma) (mean age 29.81, range 18-45 yr) and 32 volunteers as a control group (mean age 30.53, range 20-45 yr).

RESULTS

Serum leptin levels in patients were 8.49 +/- 10.76 microg/ml, and did not differ from volunteers 5.42 +/- 6.63 microg/ml. (p > 0.05). We found a direct link between increased body mass index (BMI) and serum leptin levels (p = 0.008). No association was seen between leptin and triglyceride, HDL-cholesterol, VLDL-cholesterol, eosinophil, total IgE (p > 0.05); except for total cholesterol and LDL-cholesterol (p < 0.05). Although, no correlation between allergic rhinitis and mild asthma and serum level of leptin was shown, these parameters and age correlations were stronger in female than in male (p = 0.39 for male and p = 0.011 for female), and also found direct link between increased BMI and sex and patients group (p = 0.008 for male and p = 0.0001 for female). We also determined that there was no effect of inhaled and/or intranasal steroids statistically on serum leptin levels.

CONCLUSION

Our data demonstrate that the serum levels of leptin and lipid profiles on allergic rhinitis and mild asthma were not different than those in controls.

A successful pregnancy and uncomplicated labor with C1INH concentrate prophylaxis in a patient with hereditary angioedema

Patients with hereditary angioedema (HAE) need a special concern during pregnancy. Although, the disease has a relatively benign course during pregnancy, maternal mortality has been reported. We present a HAE patient with recurrent attacks during pregnancy, but uncomplicated labor under C1INH concentrate prophylaxis.

Not all food additive related reactions originate from commercial foods: chronic urticaria due to home-made canned tomato

Additives and preservatives in commercial foods have been implicated in the etiology of chronic urticaria, but such foods have not been widely accepted. In some countries, as in ours, people prefer to use home-made foodstuffs to avoid potentially hazardous commercial additives. However, not all home-made foodstuffs are safe, especially regarding allergies. In this report, we describe a patient with chronic urticaria due to home-made canned tomato prepared using "tomato drug" as a "safe (!)" additive.

Recurrent urticaria lesions in a heparin-allergic patient: most likely another form of "recall urticaria"

In this report we describe a female patient with a history of heparin allergy and recurrent urticaria lesions at definite locations where the heparin injections were administered previously.

Skin test positivity to aeroallergens in the patients with chronic urticaria without allergic respiratory disease

The etiology of chronic urticaria and angioedema remains uncertain in most of the patients. There are several agents and factors including medications, foods and food additives, infections, contactants, inhalants, physical factors and autoimmunity that implicated in provoking urticaria symptoms. In addition, the possible role of house dust mites has been considered in a few reports. We investigated skin test positivity to house dust mites and other inhalants in 259 patients with chronic idiopathic urticaria and angioedema but without allergic rhinitis and/or asthma. Results were compared with both 300 healthy controls and 300 atopic patients. Immediate cutaneous reactivity to one or more allergens was detected in 71 patients in the study group (27.4%). The most common allergens were house dust mites (24.7%). Skin prick test sensitivity to other inhalant allergens including pollens, molds and cockroach were 7.7%, 0.4% and 0.8%, respectively. In the healthy control group 7% of patients were found as atopic with respect to skin prick test results. The most common allergens in healthy controls were pollens (6%), and house dust mites (4.7%). In atopic control group, pollens and mites are also the most common allergens detected in skin prick test (62% and 50.3%, respectively). The difference between study and healthy control group was statistically significant with respect to presence of atopy and mite sensitivity (p < 0.001). Similar differences were not established in other inhalant allergens. Significant mite sensitivity in the study group is not a coincidence. Because, ratio of skin test positivity to house dust mites in the study group was higher than the healthy controls, but was not as high as atopic patients. Furthermore, the rate of skin reactivity to other aeroallergens was not different from healthy controls. Urticaria as a sole clinical manifestation in mite sensitive patients was unusual.

Nonpigmenting solitary fixed drug eruption after skin testing and intra-articular injection of triamcinolone acetonide

BACKGROUND

Although several medications have been reported to cause fixed drug eruption (FDE) reactions, triamcinolone acetonide has not been previously described as an offending agent.

OBJECTIVE

To emphasize both an unprecedented causative agent and the extraordinary development of a FDE, we describe this response in a 42-year-old female patient.

METHODS

Because her history included a questionable reaction to corticosteroid preparations, prick and intradermal testing with triamcinolone acetonide was done to determine whether she could safely receive a triamcinolone acetonide injection.

RESULTS

Both skin test procedures and the intra-articular administration of triamcinolone acetonide caused FDEs on her right retroauricular area.

CONCLUSIONS

Because any drug may induce a FDE by any administration route, physicians should be aware of this delayed skin reaction when skin testing drugs.

Renin angiotensin aldosterone system and drug allergies complicated with hypotension

It has been discussed in several studies that non-immunologic factors, such as renin angiotensin aldosterone system (RAAS) may play a role in the pathophysiology of anaphylaxis. This study aimed to determine whether RAAS plays a part in the fall in blood pressure during drug reactions or not. Twenty patients who experienced hypotension during drug reaction and 15 healthy volunteers were enrolled in this study. None of the patients in the study or control groups were under treatment with any drug that was capable of influencing to RAAS. Serum levels of angiotensin-I (A-I), angiotensin-II (A-II), angiotensin converting enzyme (ACE) and aldosterone were measured in both study and control groups. The Mann-Whitney U test was used to compare the results of the groups. There were no statistically significant differences between the groups with respect to A-I, A-II, ACE and aldosterone levels. It was concluded that a fall in blood pressure during drug reaction must be the result of mast cell mediator effects on the vascular wall rather than RAAS impairment.

Bilateral male breast cancer and prostate cancer: a case report

Male breast cancer, consisting only 1% of all breast cancers, is occasionally associated with other primary malignancies, especially in patients with familial breast cancer history. Sporadic male breast cancers with another primary tumor are extremely rare. We report a 67-year-old male with asynchronous bilateral breast cancer and prostate cancer without familial breast cancer history.

Impact of Helicobacter pylori and Giardia lamblia infections on chronic urticaria

The etiology of chronic urticaria is largely unknown. The role of Helicobacter pylori infection, which is the most important cause of gastritis and peptic ulcer, is not clear in the pathophysiology of chronic urticaria. In this study, we aimed to define the impact of H. pylori on chronic urticaria. Thirty-eight patients who had chronic urticaria of unknown origin and dyspepsia were included in the study. In all patients, standard laboratory tests for detection of urticaria etiology were performed. Mean urticaria symptom scores of patients were carried out. All patients underwent upper gastrointestinal endoscopy. The presence of H. pylori was investigated using urease testing and histopathology. Duodenal fluid aspirated during upper endoscopy was examined for the presence of Giardia lamblia. H. pylori infection was detected in 29 patients. After successful eradication of H. pylori infection, the mean symptom score of patients did not change significantly (2.6 +/- 0.6 vs., 2.4 +/- 0.8). Only one patient had a total disappearance of urticaria symptoms. Out of 38 patients, only one had G. lamblia infection. The results of our study suggest that there is no association between H. pylori infection and chronic urticaria.

Erythropoietic protoporphyria with antinuclear antibody positivity: avoiding misdiagnosis of systemic lupus erythematosus

A young eunuchoid man was referred to our hospital with suspected erythropoietic protoporphyria. Serum antinuclear antibody (ANA) was found to be positive immediately after the porphyria attack and disappeared 30 days later. Many authors have mentioned the coexistence of systemic lupus erythematosus (SLE) and porphyria. As these two disorders have similar clinical features, the clinician must be alert and use strict diagnostic criteria in determining the presence of SLE with porphyria. In the past, elevation of ANA was reported in the cases of acute intermittent porphyria. However, there have been no reports in the cases of erythropoietic protoporphyria. In addition, the patient was found to have hypogonadotropic hypogonadism consistent with Kallmann's syndrome. To our knowledge, this report is the first case showing the coexistence of Kallmann's syndrome and erythropoietic protoporphyria. As yet, the clinical importance of this association remains unknown.

Systemic reactions due to allergen immunotherapy

The purpose of this study was to evaluate the incidence, type and potential risk factors of systemic reactions due to conventional allergen immunotherapy with aqueous extracts. The study was carried out retrospectively and included 1,506 patients to whom allergy injections had been given during the last 12 years. Symptoms in each reaction were classified with respect to time of onset, involvement of respiratory tract or skin, and presence of hypotension. The results showed 125 systemic reactions in 109 patients (1 per 1,831 injections), of which 52.8% were of the skin, 12% were respiratory symptoms, 30.4% respiratory symptoms and skin, 0.8% hypertension only, and 4% hypotension with respiratory symptoms and skin reactions. Most of the systemic reactions (84.8%) occurred within the 30 min after injection. Forty-one per cent of the systemic reactions were observed in the build-up period (1/52 patients, 1/1, 158 injections) and 58.4% in the maintenance injection period (1/73 patients, 1/2,311 injections). Seventy-six systemic reactions were related to pollen season (60.8%), 11 were related to injection from a new vial (8.8%) and eight to both pollen season and a new vial (6.4%). Thirty-five per cent of the patients who experienced systemic reactions had bronchial asthma, but there was no correlation between frequency of the two. There was also no correlation between systemic reactions and age or sex. It was concluded that immunotherapy has a low rate of systemic reactions and that maintenance immunotherapy appears to be associated with fewer such reactions than the build-up period. The 30 min waiting period is adequate for conventional immunotherapy. However, a longer waiting period may be necessary for high-risk subjects.