hossein esmaeilzadeh

Mendelian susceptibility to mycobacterial disease (MSMD) is a rare genetic disorder characterized by immunodeficiency, leading to increased susceptibility to mycobacterial infections. Studies have identified several genes that are associated with MSMD in the interferon-gamma/interleukin (IL)-12/IL-23 signaling pathway.
One of these genes is signal peptide peptidase-like 2A (SPPL2A), which is very rare, and defects in this gene have been reported only in 3 patients with MSMD. This case report presents the rare SPPL2A deficiency with an abnormal presentation, which adds to the limited number of these genetic defects.
This report presents the case of a 1-year-old boy who developed Bacillus Calmette-Guerin infection (BCGitis), lymphadenopathy, and an arm abscess that required surgical drainage following BCG vaccination. The patient had hypogammaglobulinemia, normal B-cell counts, normal CD4 counts, low CD8 counts, and SPPL2A deficiency, which is related to MSMD. The patient received a second line of anti-tuberculosis agents.
SPPL2A deficiency is associated with MSMD and can cause severe BCGitis and disruption of immunoglobulin production.

Chronic rhinosinusitis is divided into two groups, which are Chronic rhinosinusitis with nasal polyps (CRSwNP) and without nasal polyps (CRSsNP). The rate of post-surgical recurrence in the CRSwNP is high, and predicting factors are unknown. This study aims to identify and evaluate risk factors associated with treatment-resistant and recurrent CRSwNP.
This cross-sectional study evaluates demographic data and atopic risk factors in patients with CRSwNP, including a high IgE level (≥100 U/mL), skin prick test (SPT) for aeroallergens, aspirin-exacerbated respiratory disease (AERD), and asthma prevalence. An oral aspirin challenge was performed to diagnose AERD. 191 patients with CRSwNP were enrolled, with 73 patients in the recurrent, and 118 patients in the non-recurrent group. The mean age of the patients in the recurrent group was 45.08±12.05. The mean age of the patients in the non-recurrent group was 42.89±11.73. 49. Asthma prevalence in recurrent- CRSwNP is significantly higher than non-recurrent CRSwNP Asthma severity in recurrent CRSwNP and AERD patients was significantly higher than in nonrecurrent CRSwNP and non-AERD patients. The level of IgE in the recurrent- CRSwNP is higher than non-recurrent CRSwNP. Positive SPT results for tree, weed, and mite allergens were higher in the non-recurrent- CRSwNP group compared to the recurrent CRSwNPgroup.
Asthma had a significantly higher difference in AERD compared to non-AERD. The level of IgE in AERD is higher than non-AERD.
Recurrent CRSwNP patients and AERD patients had Higher IgE levels. Asthma is more prevalent and more severe in both AERD and recurrent CRSwNP. However, a positive SPT result has been seen higher in non-recurrent CRSwNP.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a rather newly described entity that can potentially end in multisystem failure in children following COVID-19 infection. The prognosis of patients with MIS-C is multifactorial; consequently, many risk factors increase the risk of mortality and severity of this disease. In this study we aimed to evaluate the prognostic effect of various parameters in mortality and intensive care unit admission of patients with MIS-C.
in this cross-sectional study, the information of patients with MIS-C were extracted in a tertiary pediatric center during a one-year period. The relationship between mortality and ICU admission of the patients with demographic information and lab data were assessed.
a total of 88 male-predominant (56.8% vs. 43.2%, P=0.135) entered the study. Seven patients had expired and 71 patients were discharged from the hospital. In our study, demographic information of the patients and their lab data were not associated with mortality except for Lactate Dehydrogenase (LDH) level. All of the expired patients had elevated LDH, while only 53.1% of the discharged patients showed increased LDH (P=0.016); on the other hand, LDH did not differ between patients who were managed in ICUs and the ones who were managed in wards.
LDH can be counted as a prognostic tool for mortality in MIS-C and might be regarded as a part of evaluation for ICU admission in this disease.

 The most frequent cause of coronary artery aneurysm in children is Kawasaki disease (KD). Recently, limited studies on procalcitonin (PCT) were performed to find a biomarker for the diagnosis or prognosis of children with KD.

 This study aimed to compare serum PCT levels between complete and incomplete KD and testify to the predictive validity of PCT for intravenous immunoglobulin (IVIG) resistance and predicting coronary artery lesions (CALs).

 This cross-sectional study was conducted at Namazi hospital in Shiraz, Iran, in 2019. All KD patients admitted to the hospital were included, with parental consent obtained. Kawasaki disease patients were categorized as complete KD (cKD) or incomplete KD (iKD). Two-dimensional echocardiography was performed, and peripheral venous blood was examined for PCT levels and other markers. All patients received IVIG and aspirin as standard treatment. The presence of coronary artery abnormalities (CAAs) was determined based on coronary artery size and morphology. We used Stata software version 14.0 for data analysis. Logistic regression models identified predictive factors for coronary complications. This study determined the optimal PCT cut-off point for predicted coronary complications using receiver operating characteristic (ROC) curve analysis. Approval was obtained from the Research Ethics Committees of Shiraz University of Medical Sciences.

 Procalcitonin values in 38 children hospitalized with acute KD ranged from 0.2 ng/mL to 10 ng/mL, with a mean of 2.65 ng/m. There was no correlation of PCT with patients’ age or gender, incomplete KD, or IVIG resistance. The serum PCT concentration was higher in patients with CAL (P = 0.009). The best PCT cut-off value for CAL prediction was 2.5 ng/mL (corresponding sensitivity = 81.8% and specificity = 68.7%), considering CAL prevalence as the studied group.

 Supplementary research is needed to determine the sensitivity and specificity of PCT for the diagnosis and prognosis of KD. Procalcitonin might be of value in predicting which children are at increased risk for CALs to intensify therapy.

Childhood stroke is linked to high personal costs for affected children and their families since more than half of the survivors are impaired for a long time, hampering their normal development and lifestyle. Thus, the present study aimed to evaluate the neurological developmental outcomes of children admitted to Namazi hospital, Shiraz, Iran, for ischemic and hemorrhagic stroke with a five-year follow-up. Ma a retrospective cohort study on children admitted to Namazi Hospital due to ischemic and hemorrhagic stroke during the past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients on follow-up. The SPSS 21.0 software was used for statistical analysis.

This is a retrospective cohort study on children admitted to Namazi hospital due to ischemic and hemorrhagic stroke during past three years (2012-2015). The information was collected by reviewing the medical records and clinically visiting the patients at the time of follow up. The SPSS 21.0 software was used for statistical analysis Settings.

The patients’ mean age at the time of stroke was 6.87 ± 4.60 years. The mean follow-up period was 3.5 ± 1.64 years. 53.1% of the children (N=17) were diagnosed with hemorrhagic stroke, and 46.9% (N=15) with ischemic stroke. The most frequent symptoms first presented by the study population were a decrease in the level of consciousness (LOC) (40.6%), headaches (37.5 %), and hand/arm/leg weakness (34.4%), respectively. The number of patients in the poor and severe outcome group was 73.3% in the ischemic and 52.9% in the hemorrhagic group.

Conclusion:

Hemorrhagic stroke was slightly more frequent than ischemic stroke, and stroke was more frequent in boys. A decrease in LOC and headaches were the most common symptoms upon admission. The left sensorimotor area was the most involved in both ischemic and hemorrhagic groups. In addition, trauma was the most common cause of stroke in this study population.

Aspirin-exacerbated respiratory disease (AERD) is a chronic inflammatory disease. It is defined by asthma, chronic rhinosinusitis with nasal polyposis, and a hypersensitivity reaction to aspirin or nonsteroidal anti-inflammatory drugs. Aspirin desensitization (AD) has been confirmed as an effective treatment to control AERD inflammation through the modulation of immune responses. We aimed to review AERD with an overview of the epidemiology, pathophysiology, and treatment. We also discussed the effect of AD on immunological markers involved in AERD pathogenesis. A search of electronic databases on AERD was performed. We included five randomized clinical trials (RCTs) on AD. We also searched databases for recent studies that investigated the effect of AD on the immunological mechanisms of AERD. RCTs have demonstrated the therapeutic effectiveness of AD on the patients’ quality of life, asthma symptom score, inhaled and oral steroid use, forced expiratory volume in 1 sec (FEV1), and inflammatory mediators. The clinical benefits of AD can occur though the regulation of innate and adaptive immune responses that are involved in the pathogenesis of AERD. In addition to the valuable effects of AD in RCTs, some side effects such as gastrointestinal bleeding, asthma exacerbation, or rash have been reported that should be considered for reaching an optimal protocol for AD.

Patients with Severe Combined Immunodeficiency are at high risk of Transfusion Associated Graft Versus Host Disease (TAGVHD) if they receive a non-radiated blood product that has a high mortality rate. This Case study reports on the case of a premature baby who had anemia of prematurity with a normal level of WBC. He received packed red blood cells, but after a while, he developed severe nausea and skin lesions. Endoscopy was done and the biopsy from the gastrointestinal lesions as well as the biopsy from the skin lesions showed graft versus host disease when he was 6 months old. However, he has received Hematopoietic Stem Cell Transplantation and is well now after about 4 months from his transplant.

A novel coronavirus disease known as Coronavirus Disease 2019 (COVID-19) has spread quickly throughout the world, and it was declared a pandemic in March 2022. Chronic granulomatous disease (CGD) is a diverse group of genetic disorders characterized by recurrent bacterial and fungal infections, resulting in granulomas due to the inability of phagocytes to destroy microbes. Even though it is thought that impaired neutrophil activity is a protective mechanism against severe COVID-19-induced cytokine storms and hyper-inflammatory responses, patients with CGD have normal immunity to most viruses. Here, we present two CGD patients who were hospitalized due to severe COVID-19 infections, which suggests that COVID-19 might have a different pathogenesis than other viruses.

 The exact description of asthma and chronic obstructive pulmonary disease overlap syndrome (ACOS) is uncertain. This study aims to determine the frequency and symptoms of ACOS and to verify certain risk factors associated with ACOS.

 Severe asthmatic patients with and without ACOS above 40 years old participated in this cross-sectional study. The receiver operating curve analysis (ROC) was used to assess the best cutoff values of age, body mass index (BMI), and spirometric data to distinguish asthma patients with overlap syndrome from asthma patients without overlap syndrome. Univariable and multivariable binary logistic regression was used to determine demographic and clinical factors that were associated with ACOS and asthma.

 Of the 88 patients, 46 (52.2%) had ACOS and 42 (47.7%) had just severe asthma. The mean age of ACOS patients (Sd) was 54.91(12.57) years and in asthma-only patients was 48.69 (13.51). The ROC analysis for age and BMI showed that age ⩾ 49 years and BMI ⩾ 27 kg/m2 were the best predictors of ACOS in this study. Spirometry data showed that the forced vital capacity (FVC) (lit) > 2.16, forced expiratory volume in the first second (FEV1) > 69, FEV1 / FVC > 96.5, and FVC (%) > 63 cut points could be used to determine the diagnostic criteria between ACOS and asthma only, respectively. Multivariate modeling showed that among the demographic and clinical variables, only age over 49 years (odds ratio [OR], 3.53 [95% CI, 1.07-11.63] p = 0.025) and living in a big city (OR, 7.42 [95% CI, 1.75-31.49] p = 0.007) were significant.

 Age over 49 and BMI above 27 have a significant association with ACOS. Also, living in a big city is considered to be another risk factor for ACOS compared with asthma. Spirometry can help distinguish ACOS from severe asthma in this study.

Elevated serum levels of IgM and recurrent infections, mainly respiratory tract infections, could be the presenting features in some ataxia-telangiectasia (AT) patients, and may initially be misdiagnosed as hyper-IgM (HIgM) syndrome. Class switch recombination (CSR), which is defective in HIgM syndrome, is an important mechanism in the maturation of B lymphocytes to produce different isotypes of antibodies in response to antigen stimulation.

The clinical manifestations and laboratory findings of 16 cases with low IgA and IgG levels, and normal to elevated IgM levels with CSR defect are reported.

In 16 cases, the median age at onset of the diseases, and median age at the time of the diagnosis were 1 year (interquartile range [IQR] = 1.6), and 4 years (IQR = 3.1), respectively. Two of the patients (12.5 %) died due to respiratory infection. In this study, Out of the studied population, four were male (25%), and 12 were female (75%). Most of the patients had consanguineous parents (81.3 %). All of the patients had ataxia, and 15 patients had telangiectasia (93.8 %), and one of the cases had malignancy (dermatofibroma). Also, 15 patients presented infections (93.8 %). Autoimmunity was seen in three patients (18.8 %). In addition, some of the patients manifested hepatosplenomegaly (31.3 %) and thrombocytopenia (18.8 %). Neurological manifestations, such as visual impairment (12.5 %), epilepsy (6.3 %), and tremor (12.5 %), were also present.

AT patients with HIgM phenotype and CSR defect, compared to other AT patients, may present different clinical manifestations, such as various infections. Considering their manifestations, the management and treatment of these patients are necessary.

Pollens have been identified as potent inducers of allergic diseases worldwide. Acer velutinum (Persian maple) tree is an important source of allergic pollens in Iran. This study aimed to identify the immunoglobulin E (IgE)-reactive components of A. velutinum pollen extract in patients with maple allergy. We aimed to evaluate its allergenic components; using IgE in the serum of patients with maple allergy. Twenty-two patients with a clinical history of reaction and a positive skin-prick test to maple pollen extract were included in this study. Identification of IgE-binding proteins in A. velutinum pollen extract was performed by immunoblotting using sera from sensitive patients. A protein band with a molecular weight of around 70 kDa was the most IgE-reactive allergen in A. velutinum pollen extract detected by this method. Identification of a protein with a molecular weight of about 70kDa, as the most reactive allergen of A. velutinum pollen extract, can be considered as a potential allergen for designing diagnostic kits or as a target for immunotherapy of allergic patients with maple allergy.

Aspirin exacerbated respiratory disease (AERD) is known by the triad of chronic rhinosinusitis with nasal polyposis (CRSwNP), aspirin hypersensitivity, and asthma, but its etiology and physiopathogenesis are still unclear. This cross-sectional study was designed to investigate allergy and inflammatory cells (neutrophils vs. eosinophils) dominancy in nasal polyp tissue of patients with AERD compared to non-AERD patients. CRSwNP patients scheduled for endoscopic sinus surgery were recruited in this study. Nasal polyp tissue was analyzed for infiltrating cells, and Eosinophil dominant and neutrophil dominant polyps were determined. AERD was confirmed by oral aspirin challenge (OAC). Demographics data; history of asthma, exacerbation by using NSAIDs, routine use of aspirin, type of surgery (primary or revision), and results of skin prick test and spirometry were recorded. Pathology results and contributing factors compared between AERD and non-AERD patients. Sixty-five patients (39 women, 26 men) were enrolled in the study (mean age 38.83 ± 12.43 years). Thirty (46%) patients had positive OAC tests. Totally 41 patients (63.1%) had eosinophilic polyps. 80% of patients with eosinophilic polyp had positive OAC and were AERD (P < 0.05). There was no significant difference in demographics, revision surgery, and concomitant asthma between AERD and non-AERD groups (P > 0.05). The positive skin prick test was higher in AERD and also in eosinophilic polyp patients, but it was not statistically significant (P = 0.086 and P = 0.177). Eosinophilic polyps are more common in AERD. A positive skin prick test is associated with AERD and eosinophilic polyp.

Asthma is one of the most common respiratory diseases caused by chronic airway inflammation. A complex network of cytokines could affect asthma development.IL-4, IL-13, IL-17, and IL-33 have been identified as cytokines associated with asthma severity and these cytokines can be considered as candidate biomarkers for predicting the asthma severity while the IL-10 is lower in asthmatics compared with healthy subjects. There are many controversies about the IL-22, IL-25, and TGF-β levels between the Iranian publications. No significant differences have been observed between the healthy subjects and the asthmatic cases regarding the IL-6 and IL-8 levels.

Epigenetics is the study of how your behaviors and environment can cause changes that affect the way your genes work. Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence.Epigenetics is defined as inherited changes in gene expression, without actual changes in gene DNA sequence. Epigenetic modifications are biochemical changes in chromatin, DNA, or histones that are functionally related but do not affect the nucleotide sequence of the genome.Epigenetics  and its role in  autoimmune diseases and allergies were sought.

: Pubmed and Google Scholar databases were searched using the key words: Epigenesis, autoimmune diseasesand allergic diseases for the past twenty years. Related articles were assessed and reviewed by the authors.

Allergic and autoimmune diseases such as asthma, multiple sclerosis (MS) or rheumatoid arthritis (RA)can developed due to inappropriate immune responses to harmless foreign allergens (allergic disease) or to autoantigens (autoimmune disease).

Epigenetic mechanisms have recently been studied more extensively because they are environmentally influenced and can alter disease polymorphisms in a similar way.Epigenetic modifications affect (or are affected by) various environmental factors that both protect against allergies and transmit allergies.Changes in DNA methylation patterns may predict disease susceptibility prior to onset and be associated with a lack of persistent response to allergens.New technological approaches such as epigenetic editing and DNAzymes provide new methods for the treatment of allergic diseases

Bacillus Calmette Guerin (BCG) was designed for protecting children against tuberculosis. Also, it can protect against other infectious diseases through the induction of trained immunity. Due to its heterologous protective effects, the BCG vaccine has been proposed as a treatment option for coronavirus disease-2019 (COVID-19). Epidemiological studies have found that countries without BCG vaccination policy have experienced higher mortality rates related to COVID-19 infection than those with BCG vaccination policy. However, there are some confounding factors such as age, population intensity, immigration, the pandemic phase, and data accuracy that may affect these results. Therefore, this hypothesis should be evaluated by clinical trial studies. Large-scale clinical trials are in progress to investigate if the BCG vaccine could be used as a useful tool for protection against COVID-19 infection.

Asthma is chronic respiratory inflammatory disease with prevalence of 10-20% in children and 5-10% in adults. Main treatment of asthma constituted of inhaled corticosteroids (ICS) which can impede the progression of pathology in asthmatic patients. Potentially side effects of corticosteroids may prevent some patients from taking medication, which can increase exacerbation and and severity of asthma. We aimed to investigate the prevalence and reasons of fear towards corticosteroids in asthma patients. In this cross-sectional study asthma patients viewpoint regarding inhaled and oral corticosteroids in the management of asthma was assessed using questionnaire. Exclusion criteria were the patients afflicted with chronic respiratory diseases other than asthma and the ones who were taking corticosteroids for other reasons. The data were analyzed using SPSS version 25. 50.7% of patients were male. The mean age of the subjects was 10.71 years and the mean duration of disease and treatment course were 3.2 and 2.2 years respectively. 75.4% of patients had regular follow-up. 56.6% did not know the mechanism of action of corticosteroids in asthma and 75.4% of patients had concerns regarding the adverse effects of corticosteroids. The most common concerns reported were drug dependency (14.9%) followed by osteoporosis (14.3%). 40.8% of patients claimed that they use corticosteroids with peace of mind if their physician prescribes them. 75%of patients had concerns regarding the adverse effects of corticosteroids and the most common concerns reported were drug dependency (14.9%).

Context:

 Chronic airway inflammation in asthma is affected by a complex network of interacting cytokines. The exact role of each cytokine in childhood asthma development has remained poorly understood. In this study, we aimed to review articles investigating cytokine levels and polymorphisms in childhood asthma among the Iranian population to assess susceptible cytokines related to childhood asthma.

Evidence Acquisition: 

We performed a literature search in PubMed, Scopus, Science direct, and Embase databases to find articles that have evaluated the cytokine levels and gene polymorphisms in childhood asthma among the Iranian population until March 2, 2020. The terms used to search included “cytokine”, “interleukin”, “polymorphism”, “Asthma”, and “Iran” in the international databases. Only case-control studies with a healthy control group that investigated cytokine levels and polymorphism in childhood asthma among the Iranian population have been included.

Considering these criteria, we extracted 7 articles from international databases and included them in the current review. We investigated 4 cytokine levels and 4 cytokine polymorphism patterns in asthmatic and non-asthmatic subjects in Iran. Interleukin (IL)-23, IL-17, and IL-33 levels were statistically higher in asthmatic children, and also IL-33, IL-17 levels were associated with asthma severity. There were no significant differences between healthy and asthmatic subjects regarding IL-35 levels. Polymorphisms in cytokine IL-4, IL-10, tumor necrosis factor (TNF)-α, and IL-2 were susceptible to childhood asthma in the Iranian population. 

Increased IL-33 and IL-17 levels were related to disease severity in childhood asthma. Four cytokine polymorphisms (IL-4, IL-10, IL-2, and TNF-α) were associated with the risk of pediatric asthma in the Iranian population.

 Henoch-Schönlein purpura (HSP) is one of the most common systemic types of vasculitis in children. Although it is a self-limited disease, life-threatening complications such as nephritis may occur. Early diagnosis and follow up might improve the long term outcome in renal involvement. There are few studies that have evaluated HSP in Iran.

 The purpose of this study was to investigate demographic, laboratory data and clinical presentations of admitted HSP patients in a tertiary referral center, over a twelve-year period.

 This retrospective descriptive study evaluated 195 patients, diagnosed with HSP, who were admitted to Namazi Hospital in southwest of Iran (2006 - 2018). Demographic, clinical and laboratory findings, as well as treatment outcome of HSP patients were collected.

 There were 118 males and 77 females with the mean age of 6.7 ± 3.21 years. About 70 (36%) patients showed common cold symptoms two weeks before HSP presentations. Admission course was 1 - 17 days (mean 4.55 ± 2.83) and autumn was recorded with the highest number of admitted patients (44.1%). In the course of hospitalization, 100% of the patients presented with palpable purpura, 61.02% with joint pain and 19.49% with abdominal pain. Moreover, 17.95% of the patients were noted with renal involvement. Laboratory data shows that more than half of patients (54%) had leukocytosis, only 9% of patients had positive CRP but all the patients had high erythrocyte sedimentation rate (ESR). Total of 43.1% of the patients received corticosteroids.

 The observed number of male patients with HSP was higher than females and the highest frequency of the HSP cases was observed in autumn. Joint pain and abdominal pain were the predominant clinical presentations, following skin purpura. The presented data can help with further HSP diagnosis and treatment plan.

Because some children have allergies to egg as an important food source, finding the right alternative is essential. To date, the interaction between other birds’ eggs and hen egg has not been investigated in Iran. Because of the common usage of eggs from birds other than hens in Iran, the present study aimed to compare hens’ eggs with the eggs of other birds. In this case-control study, 70 children who referred to our allergy clinic were evaluated. In patients who had a history of egg allergy, SPT and specific IgE Ab analyses were done, and then an oral food challenge (OFC) was performed. Patients with egg allergy underwent skin prick tests with eggs from birds such as turkey, goose, duck, quail, partridge, and pigeon. From 40 patients with egg allergy, 8 patients passed the OFC. The greatest cross-reactions were seen in turkey and quail egg extracts. The least cross-reactions were reported in partridge and pigeon. Among patients who had negative SPT with partridge egg (N=3), one patient passed and two failed the OFC. Three of the patients who had negative pigeon SPT (N=5) passed the OFC with pigeon egg. In conclusion, turkey, goose, duck, and quail eggs cannot be used as an alternative to hen eggs; only partridge or pigeon eggs can be considered as a suitable alternative to hen eggs.

Ataxia-telangiectasia is a multi-system disorder in which neurologic impairment and immune deficiency are observed. In the present study, patients with ataxia-telangiectasia were followed to provide information regarding clinical and immunological features.

We report a case series of 18 patients diagnosed with ataxia-telangiectasia, who were referred to a tertiary center of clinical immunology from 2008–2018. Clinical presentations, medical records and lab data were observed during this period with a mean follow-up time of 4.57 ± 2.66 years.

The mean age of the patients was 10.92 ± 3.24 years (11 females and 7 males). Thirteen patients (72.22%) were from families with consanguinity. Ataxia was the most common clinical feature, observed in 18 (100%) patients. The predominant clinical presentations were tremor and oculocutaneous telangiectasia, observed in 14 (77.8%) patients; dysarthria and oculomotor apraxia, observed in 13 (72.2%) patients. Infections were recorded in 12 (70.6%) patients. Decreased IgG level and IgA levels were observed in 5 (33.3%) and 6 (40.0%) patients, respectively. Decreased B-cell number and T-cell number were noted in 7 (46.67%) and 11 (73.33%) patients, respectively. Three (16.7%) patients were diagnosed with acute lymphoblastic leukemia and two of them expired subsequently.

Ataxia-telangiectasia is a progressive disease with no established therapy; so, it necessitates early diagnosis and follow-up of the patients. The presented clinical and immunological data in this study may help with diagnosis and management of the disease complications.

Fungal aeroallergens might sensitize the airway which in turn produces a specific cytokine profile.

To evaluate the IL-25 and IL-33 profile in patients with fungal allergic rhinitis.

The present study examined patients who were evaluated due to allergic rhinitis (AR) at Emam Reza Hospital of Shiraz, Iran. The allergic patients were categorized based on the skin prick test. Blood samples were collected and allergen-specific IgE and cytokine profiles were analyzed.

184 patients were enrolled in the study and in 35 of whom fungal rhinitis was confirmed. The levels of specific IgE in patients with fungal allergy were statistically significant compared to those in the control group (p<0.000). However, there were no significant differences in IL-25 and IL-33 levels between fungal and none-fungal AR patients.

Chronic fungal challenge might regulate innate system cytokines in severe persistent AR.

Most children with asthma start to have symptoms in early life; socio-demographic and environmental factors can play an important role in the development and clinical expression of asthma. The aim of this study was to determine risk factors in children with asthma from southwestern Iran. This cross-sectional study included children with asthma, aged five to 15 years, who frequently referred to the allergy outpatient clinics affiliated to Shiraz University of Medical Sciences during year 2016. Information about the participants’ demographic characteristics and social and environmental factors was collected using a questionnaire during year 2016. A total of 737 children (494 males and 243 females) with asthma with mean age of 8.1 ± 2.7 years were recruited. Various factors, including male gender, low birth weight, being the first child, low number of siblings, no vaccination against influenza, adenoidectomy, and young age of mother were found to be associated with an increased risk of asthma during childhood. About 50% of children ate little fish and drank too much cola in a week. The current study showed that influenza vaccination and consumption of fish should be encouraged; also, the rate of adenoidectomy was high in asthmatic patients. The results of this study can help plan strategies for preventing asthma.

Severe cutaneous adverse drug reaction (SCAR) is considered to be a multifactorial drug side effect. This study was designed to investigate the epidemiology and human leukocyte antigen (HLA)-A and -B gene polymorphisms in pediatric patients with SCAR admitted in tertiary referral center, southwestern of Iran from 2013 to 2017. Demographic data, past allergy and autoimmune history, clinical presentations, drugs confirmed to be the cause of SCAR as well as its therapy were reviewed for each patient. HLA-A and -B allele frequencies were determined in 40 of the patients using polymerase chain reaction based on sequence specific primers (PCR-SSP) and compared with 40 healthy individuals as control group.Sixty-one patients with mean age of 6 years old and boy to girl ratio was 1.2/1 in this study. The most common type of SCAR in our patients was Steven Johnson Syndrome (SJS)/Toxic Epidermal Necrosis (TEN) mainly caused by beta-lactam antibiotics. Carbamazepine was the second cause of drug–induced SCAR. Moreover, HLA-A*02:01 and A*51:01 were related to the increased risk of SCAR while A*11:01 seemed to be protective against SCAR. HLA-A*02:01, HLA-A*24:02, and HLA-B*51:01 showed associations to the increased risk of SJS. Based on our results, beta-lactam antibiotics and antiepileptic drugs are the most common causes of severe adverse drug reaction in southwestern Iranian pediatric patients. Moreover, some HLA-A alleles can influence risk of SCAR.

Drug allergy is subtype of adverse drug reactions that is mediated by immunologic mechanism. Sever drug allergy is poorly understood in children that leads to hospitalization.
The goal of this research was to study severe drug hypersensitivity reactions in hospital-admitted children in southwestern Iran.
This is a retrospective study conducted in Namazee hospital, southwestern Iran, the medical records of 33 children with drug allergies during 2011 till 2014 were reviewed.
Drug allergies have mainly been studied in adults. In the current study, 19 patients were females (57.9%) and 14 were males (42.1%). Maculopapular rashes were seen in 90.9% of these patients (30 persons). Overall, drug reactions were seen more commonly in females. The mean age was also higher in females. The highest rate of drug reactions were seen with beta lactams and phenobarbital, including 42.4% of patients (14 persons) and 39.4% of patients (13 persons), respectively. Dress syndrome and Steven-Johnson syndrome were the most common reactions in these patients, including 27.3% (9 persons) and 24.2% of patients (8 persons), respectively. Toxic epidermal necrosis was the least common reaction in the patients, involving only 6.1% of patients (2 persons).
Maculopapular rashes were the most common drug reactions. In the current study, drug rash with eosinophilia and systemic symptoms (DRESS) syndrome was the most common and toxic epidermal necrolysis (TEN) was the least common cause of admission.

Despite the increasing prevalence of anaphylaxis, there is little information about the characteristics and practice of healthcare providers in treating anaphylaxis, so this study was conducted to record the characteristics and therapeutic approaches of anaphylaxis from May 2012 until April 2015, the data of all patients diagnosed with anaphylaxis in the Allergy department of three referral university hospitals in Tehran, Iran were recorded. Thereafter, the demographics, clinical features, triggers and therapeutic approach were evaluated. This study investigated 136 individuals, 64 males (47%) between 6 months and 68 years old, as well as 72 others (52.94%) under 18 years of age (pediatric). The following were the most common organs involved: Skin 86.02% (pediatric 91.66% vs adult 79.68%), respiratory tract 51.47% (pediatric 43.05% vs adult 60.93%), cardiovascular 50.73% (pediatric 54.16% vs adult 46.87%), gastrointestinal 20.58% (pediatric 27.7% vs adult 12.5% ) and neurologic system 5.88% (only in adults). The following were the most identified causing foods 69 (50.37%)[42 pediatric (children) and 27 adults], drugs 34( 25%)[14 pediatric and 20 adults], idiopathic 16( 11.77%)[3 pediatric and 13 adults], insect sting 7( 5.15%)[3 pediatric and 4 adults] , exercise 6( 4.42%) [1 pediatric and 5 adults]. Milk, egg and wheat were the most common causative foods in pediatric cases but sesame, as well as egg and milk were the most common causes in adults. Epinephrine injection, auto injector epinephrine prescription as a discharging plan and referral to an allergist were: 10.78, 1.96 and 7.8 %, respectively. In this case series we found that, cutaneous, respiratory, cardiovascular and gastrointestinal complains were the most common manifestations and food, drug and idiopathic were the most common causes.In this study, the diagnosis of anaphylaxis, epinephrine subscription and referral to an allergist were significantly lower in comparison to other studies.