Relevance of patch testing in patients of chronic spontaneous urticaria and its correlation with serum IgE level

Objectives: Chronic spontaneous urticaria (CSU) is defined as short lived (< 24h) wheals occurring spontaneously without any triggering factors, daily or almost daily for at least 6 weeks. Though CSU is mainly a Type 1 hypersensitivity reaction, earlier studies suggested contact allergy may have some role to play an important role in the etiopathogenesis of CSU. The objective of the study is to find out the relevance of patch test in the etiopathogenesis of and its correlation with serum IgE level. Materials and Methods: Thirty-one patients of CSU were thoroughly evaluated for clinical and laboratory parameters. We conducted patch testing with Indian Standard Series (ISS) in all of them and tried to find out the relevance of every positive reaction. Relevant positive cases were asked to avoid exposure for 2 months and were maintained only in breakthrough antihistamines. Furthermore, correlation of positive patch test reaction with high IgE and eosinophil count were studied. Results: Seventeen (55%) cases came positive for patch test. Potassium dichromate, lanolin, benzocaine, and fragrance mix were the most common offenders. Patients with very high IgE count had patch test positivity with multiple allergens. Seven of the fifteen patients who had relevant positive patch results could be followed up to remission; three were lost to follow-up. Conclusion: Patch test with ISS may give important clue to in a subset of patients of CSU and thus may be considered an important part of routine investigations of CSU.

Indigo Pulverata Levis (Chung-Dae, Persicaria tinctoria) Alleviates Atopic Dermatitis-like Inflammatory Responses In Vivo and In Vitro

Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with a type 2 T helper cell (Th2) immune response. The IndigoPulverata Levis extract (CHD) is used in traditional Southeast Asian medicine; however, its beneficial effects on AD remain uninvestigated. Therefore, we investigated the therapeutic effects of CHD in 2,4-dinitrochlorobenzene (DNCB)-induced BALB/c mice and tumor necrosis factor (TNF)-α- and interferon gamma (IFN)-γ-stimulated HaCaT cells. We evaluated immune cell infiltration, skin thickness, and the serum IgE and TNF-α levels in DNCB-induced AD mice. Moreover, we measured the expression levels of pro-inflammatory cytokines, mitogen-activated protein kinase (MAPK), and the nuclear factor-kappa B (NF-κB) in the mice dorsal skin. We also studied the effect of CHD on the translocation of NF-κB p65 and inflammatory chemokines in HaCaT cells. Our in vivo results revealed that CHD reduced the dermis and epidermis thicknesses and inhibited immune cell infiltration. Furthermore, it suppressed the proinflammatory cytokine expression and MAPK and NF-κB phosphorylations in the skin tissue and decreased serum IgE and TNF-α levels. In vitro results indicated that CHD downregulated inflammatory chemokines and blocked NF-κB p65 translocation. Thus, we deduced that CHD is a potential drug candidate for AD treatment.

IgE is associated with exacerbations and lung function decline in COPD

Background Both allergen-specific IgE and total IgE in serum play a major role in asthma. However, the role of IgE in chronic obstructive pulmonary disease (COPD) is poorly understood. It was the aim of this study to systematically analyze the relationship between serum IgE levels and disease characteristics in large COPD cohorts. Methods COSYCONET is a comprehensively characterized cohort of patients with COPD: total IgE and IgE specific to common aeroallergens were measured in serum of 2280 patients, and related to clinical characteristics of the patients. WISDOM is another large COPD population (2477 patients): this database contains the information whether total IgE in serum was elevated (≥ 100 IU/l) or normal in patients with COPD. Results Both in COSYCONET and WISDOM, total IgE was elevated (≥ 100 IU/l) in > 30% of the patients, higher in men than in women, and higher in currently than in not currently smoking men. In COSYCONET, total IgE was elevated in patients with a history of asthma and/or allergies. Men with at least one exacerbation in the last 12 months (50.6% of all men in COSYCONET) had higher median total IgE (71.3 IU/l) than men without exacerbations (48.3 IU/l): this difference was also observed in the subgroups of not currently smoking men and of men without a history of asthma. Surprisingly, a history of exacerbations did not impact on total IgE in women with COPD. Patients in the highest tertiles of total IgE (> 91.5 IU/ml, adjusted OR: 1.62, 95% CI 1.12–2.34) or allergen-specific IgE (> 0.19 IU/ml, adjusted OR: 2.15, 95% CI 1.32–3.51) were at risk of lung function decline (adjusted by: age, gender, body mass index, initial lung function, smoking status, history of asthma, history of allergy). Conclusion These data suggest that IgE may play a role in specific COPD subgroups. Clinical trials using antibodies targeting the IgE pathway (such as omalizumab), especially in men with recurrent exacerbations and elevated serum IgE, could elucidate potential therapeutic implications of our observations.

Atopic dermatitis and its association with serum immunoglobulin E levels: our experience in KVG medical college and hospital, Karnataka

<p><strong>Background:</strong> Eczema is an inflammatory skin reaction which presents as acute, subacute and chronic forms. Eczemas persisting for more than 6 weeks or characterized by thickening and discoloration of skin is typical of chronic eczema. Atopic dermatitis (AD) is a type of chronic or chronically relapsing eczematous skin disorder. To determine the percentage of AD in all forms of chronic eczema by using HRC. We also estimated serum immunoglobulin E (IgE) levels and determined its correlation with chronic eczemas and with various clinical parameters of HRC.</p><p><strong>Methods:</strong> A total of 50 patients with chronic eczema meeting defined inclusion and exclusion criteria were enrolled in this cross-sectional study after taking an informed consent and approval of institutional ethical committee. All patients were subjected to a detailed history based on a questionnaire. A thorough clinical examination was done to determine all major and minor clinical parameters of HRC for AD. Blood samples were collected and AEC and total serum IgE levels were determined.</p><p><strong>Results:</strong> Most of our study patients were females (64%). Majority of males (77.7%) were farmers and majority of females (56.2%) were housewives assisting in fieldwork activities. Various causes of chronic eczema were clinically diagnosed AD (34%), chronic actinic dermatitis (8%), polymorphic light eruption (4%), airborne contact dermatitis (10%), phyto-photodermatitis (10%), chronic hand and/or foot eczema (16%) and seborrheic dermatitis (2%). Thirty-two patients (64%) satisfied HRC. Among all clinical parameters of HRC, pruritus and xerosis were the commonest in AD patients. Serum IgE level was raised in 58% of chronic eczema and 68.7% of AD patients.</p><p><strong>Conclusions:</strong> Serum IgE levels showed significant association with typical morphology and distribution of lesions, early age of onset and perifollicular accentuation.</p><h2> </h2>

PAHs Changed Epigenetics by One Carbon Metabolism in Childhood Asthma

Background: Epigenetic mechanisms may play a role in which PAHs exert its adverse effects in childhood asthma. However, the underlying molecular mechanism remain to be fully elucidated. This study aimed to investigate this process in view of cellular metabolism, especially one carbon metabolism. Methods: Fifty asthmatic children and fifty control subjects were recruited in this study. Serum IgE and IL-17A was detected by ELISA assay. Serum PAHs levels were measured by GC-MS. One carbon-related metabolites were determined by UPLC-Orbitrap-MS. Blood DNA methylation in long interspersed nucleotide element-1 (LINE-1) was analyzed by bisulfite sequencing PCR. ChIP assays were used to examine H3K4me3 modifications on IL-17A gene. Multivariable linear regression was performed to evaluate the associates between PAHs and DNA methylation and histone methylation mediated by one carbon metabolism. Results: The asthmatic group presented significantly higher total serum IgE and IL-17A levels. Serum Fla was associated with childhood asthma. The asthmatic group displayed a significantly decreasing in SAM abundance and a smaller but corresponding decrease in SAH, which indicated the increasing conversion from SAM to SAH and the elevated capacity of methylation reactions. Fla had a great effect on one carbon metabolites, especially SAH, SAM and Ser, which exerted significant mediation effects between the Fla level and asthma. What’s more, Fla had a positive effect on LINE-1 DNA methylation (β=0.395, P=0.000) and H3K4 tri-methylation level in the IL-17A promoter region(β=0.293, P=0.002). We did find significant mediation effect between serum Fla and asthma by LINE-1 DNA methylation and H3K4me3 level in the IL-17A promoter region.Conclusion: PAHs disturbed one carbon metabolism to influence the methyl group refill of DNA methylation and histone methylation, which may elevate serum IL-17A level in asthmatic children.

Atopy in Kashmir-validation from a case control study with respect to IgE and Interleukin genes

Objectives Increased levels of serum Immunoglobulin-E (IgE) and different genetic variants of cytokines are common biochemical manifestation in Allergy. The current study was aimed to study the association of IgE and different variants of Interleukin-4 (IL-4), and Interleukin-13 (IL-13) genes with different kind of allergies. Methods A pre-tested questionnaire was used to collect all the dietary, life style and clinical details by a trained staff. A blood sample of 2 ml each was collected in coagulated and anti-coagulated vials. DNA and serum samples were extracted and stored until further use. Serum IgE were estimated by ELISA while as the genotypic analysis was done by PCR–RFLP methods. Results Statistically a significant difference of serum IgE levels were observed among cases and controls (P < 0.05). The observed significant difference of serum IgE levels were retained among subjects who also harboured variant genotypes of IL-4 and IL-13 genes (P < 0.05). Additionally, the above genetic variants significantly modified the risk of allergy when stratification was done based on various clinical characteristics. Conclusion Our study suggests that increased IgE levels and in association with variant forms of IL-4 and IL-13 genes are significantly associated with different types of allergies in study population.

Acupoint Autohemotherapy Attenuates DNCB-induced Atopic Dermatitis Lesions by Regulating Th1/Th2 Cytokine Balance in BALB/c Mice

Objective Acupoint autohemotherapy (A-AHT) is considered an effective therapy for atopic dermatitis (AD) with few side-effects. Previous experiments showed the treatment had the potential to regulate T helper (Th) 1 and Th2 cytokines, like interferon (IFN)- gamma and interleukin (IL)- 4. This study focuses on the effects of A-AHT on the AD-like skin lesions through regulating Th1/Th2 immune responses. Methods The treatments of A-AHT, sham acupoint autohemotherapy and acupoint injection of normal saline were administered in the AD mice once every other day for 4 weeks. The total immunoglobulin (Ig) E, IL-4 and IFN-γ cytokine levels in the serum were examined after animal sacrifice. Th1/Th2 expression was analyzed in murine spleen cells via flow cytometry and immunohistochemical analysis of GATA-3 and T-bet in skin lesions were further assessed. Results Either type of repeated autologous whole blood (AWB) injection (into acupoint or sham acupoint) reduced the severity of AD-like symptoms and level of serum IgE. All of the three treatments had the similar inhibitory effect on levels of IL-4 and upregulation on the ratio of IFN-γ/IL-4, while differed on Th1/Th2 ratio as A-AHT regulates the body’s Th1/Th2 shift. This treatment also increased the related transcription factors T-bet expression, and upregulated T-bet/GATA3 ratio compared with the DNCB group. These differences were significant only in A-AHT group. Conclusion A-AHT effectively reduces AD symptoms and serum IgE levels in a mouse model and may act by regulating Th1/Th2 immune responses.

Correlation of absolute eosinophil count, nasal smear eosinophilia and serum IgE levels in allergic rhinitis

Allergic rhinitis (AR) is one of the most common disease in India. The association between eosinophils and allergic diseases has been known since many years. To correlate Nasal smear eosinophilia (NSE), blood absolute eosinophil count (AEC) and total serum IgE levels with severity of the clinical score in patients with allergic rhinitis. This is one-year prospective study in patients (n=60) presented with allergic rhinitis to our institute. After taking consent, all the study participants were subjected for blood AEC, IgE levels and nasal smears for eosinophils. Among the samples, 81.7% were males. The mean age of patients was 35.2 years. AEC &#62; 440 cells/cu.mm was seen in 46.6%, NSE&#62;10% in 81.6% and total serum IgE was elevated &#62; 100 IU/ml in 95.0%. There was a good correlation of NSE and serum IgE with the severity of disease. There was no correlation of blood AEC with the severity of clinical score. Data was analysed using SPSS software.rn NSE and IgE both correlated well with severity of the disease. Nasal smear cytology is a simple procedure having good correlation with severity of clinical score should be used routinely. Testing for serum IgE levels will increase the accuracy with a better diagnostic utility.