Iranian Journal of Allergy, Asthma and Immunology
Volume:3 Issue: 1, Mar 2004

The bulk of our knowledge on immunosuppression in malnutrition comes from the experiments done on cell-mediated immunity. However, malnutrition-induced modifications of humoral immunity have been less understood. The objective of this study was to determine the effects of acute protein-energy malnutrition on serum levels of immunoglobulins and their subclasses in murine models. Male and female C57BL/6J mice were allocated to one of the four groups: (1) zero-time control (ZC) (19 days of age); (2) ad libitum intake of a complete purified diet (control group [CG]); (3) restricted intake of the complete diet (restricted group [RG]); and ad libitum intake of an isocaloric low-protein diet (low-protein group [LP]). The three groups other than the zero-time control were maintained on their respective regimens for 14 days, i.e. from 19 through 33 days of age. The restricted intake protocol produced weight loss through energy deficiency (marasmic-type malnutrition), whereas the low-protein diet caused wasting through inadequate protein nitrogen and induced a condition mimicking incipient kwashiorkor. Though serum levels of IgG1 and IgE (Th2-type immunoglobulins) in RG and LP mice were significantly higher than those in CG mice, serum levels of IgG2a and IgG3 (Th1-type immunoglobulins) did not show any significant difference between those three groups. Interestingly, serum levels of IgG2b (another Th2-type immunoglobulin) in LP mice were significantly higher than those in CG and RG mice. In ZC mice serum levels of total IgG, IgG1, IgG2b and IgG3 were significantly higher than those in the other three groups. We concluded that during acute malnutrition, Th1/Th2 balance is apparently shifted towards Th2 arm. This deviation seems to be more prominent during acute protein deficiency. The increased serum levels of immunoglobulins in ZC mice were probably due to the intestinal uptake of those proteins from maternal milk.

This study was conducted to examine if allergic contact dermatitis (ACD) alters the expression of MMPs in human dermal fibroblasts. Fibroblasts are the primary source for MMP and matrix production in skin. MMPs are known to involve in a number of physiological and pathological processes. Some published data indicated a gelatinase-like activity in acute and chronic phases of allergic contact dermatitis. However, no exact source of gelatinase activity was demonstrated. Moreover, little is known about the role of MMPs in immune responses.To study and predict the pathophysiological effects of (MMP-2) in allergic contact dermatitic (ACD) patients, we established an in vitro tissue culture survey based on fibroblast explanted from ACD wounds and normal tissues respectively. We also employed a precise proliferation assay [i.e. MTT; 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] to analyze and compare three ACD vs. three normal cell strains. Parallel to MTT assay, we assessed the activity as well as the kinetics of gelatinase (MMP-2) in conditioned media using a zymogeraphy analysis. There was a significant difference in proliferation capacity between mean ACD fibroblast strains vs. mean normal cells, particularly in days 6 to 8 post explantation, 492.5±6.6 vs. 361.75±8.25 respectively. Zymoanalyses indicated significant differences between ACD cells and normal fibroblasts both in time-course and MMP-2 activity per cell fashions, 163.7±16.21 for mean ACD fibroblasts vs. 130±9.09 for normal cells respectively. These data suggest that fibroblasts overproliferated in the process of ACD. Moreover, simultaneous overexpression of MMPs observed in ACD fibroblasts vs. normal strains, is indicative of altered fibroblast functionality in the process of allergic contactdermatitis. The activity per cell analysis showed that MMP-2 expression in ACD fibroblasts is independent of cell number, suggesting that either intra- or inter-cellular control signals are also altered and that ACD fibroblasts exhibit hyper-responsiveness to mitogenic or fibrogenic stimulants. Altogether, these data address the chronocity and non-healing tendency of ACD wounds. However, more studies are required to examine possible MMPs inhibition and differential expression of mytogenic, fibrogenic and antifibrogenic cytokines in ACD wound beds. In particular, MMP-2 is postulated to be an aim for further gene therapy protocols

The human leukocyte antigen has become a key component in investigating the genetic relationships between populations. The aim of this study was to determine the genetic diversity of HLA class I and II alleles among Zaboli ethnic group of South-east Iran to establish a database for further investigations on ancestry and the genetic factors contributing to complex diseases in this region.Unrelated individuals from the Southeast geographic location throughout Iran were serologically typed using standard microcytotoxicity assays with commercial and local trays. The ethnic background of each individual was self-defined. HLA profiles were determined in 41 Zaboli populations. The most frequent class I alleles of the Zaboli ethnic group being the following: HLA-A1 (34.1%), -A2 (58.5%), -A11 (29.3%), -A24 (23.9%), -B5 (70.7%), -B16 (26.8%), and -Cw4 (24.4%). The class II alleles more frequently observed in this group were HLA-DR1 (26.8%), -DR2 (26.8%), -DR3 (31.7%), -DR4 (29.3%), -DR7 (24.4%), -DR8 (22%), -DR11 (48.8%), -DRw52 (73.2%), -DRw53 (53.7%), -DQ1 (53.7%), -DQ2 (31.7%), and -DQ3 (29.3%). This report utilized a first study of HLA class I and II typed individuals, from widely dispersed areas of Iran. This will help in studies related to disease associations and cadaver organ allocation programmes.

This study was conducted to evaluate whether forced expiratory volume in 1 second (FEV1) for the diagnosis of bronchial reactivity by means of the free-running exercise test and bronchodilator inhalation, could be appropriately replaced by simple measurements of peak expiratory flow rate (PEFR) in children.We studied 108 referred symptomatic children (due to chronic cough or wheezing) suspected to have asthma aged 5-14y. Forced breathing spirometry and the “Mini-Wright peak flow meter” tests were recorded before and fifteen minutes after the challenge with free– running exercise or bronchodilator (Salbutamol) inhalation, regarding the baseline FEV1 value (FEV1> 80% considered as normal).There was a high correlation between PEFR and FEV1 (in absolute value and percent predicted) measured before and after bronchodilator inhalation test (r = 0.48, P = 0.05) in comparison to the values referred to free– running exercise test (r = 0.26, P = 0.01).“forced breathing spirometry” and “Mini–Wright peak flow” cannot be used interchangeably for diagnosing asthma, and PEFR measurement should remain a procedure for monitoring and following up the patients.

This descriptive study was conducted to determine the prevalence of asthma and related symptoms among 6-7 and 13-14 year old school children in Tehran as a part of International study of Asthma and Allergies in childhood (ISAAC) phase III. The ISAAC written questionnaire was given to a total of 6127 students of 72 schools in urban area of Tehran. Simple random sampling was performed with a uniform distribution throughout 12 clusters of 2 divisions of the municipality. All 6-7 and 13-14 year old students were enrolled in this study. Results showed that 15% of the 6-7 year olds and 17% of the 13-14 year olds had positive history of wheezing among which 8.6% and 10.6% respectively had had recent attacks. Physician confirmed asthma was reported in 2.1% of the 6-7 year olds and 2.6% of the 13-14 age group. Severity of asthma assessed by frequency of speech limitation due to wheeze was positive in 1.5% of 6-7 aged group and 3% of 13-14 year olds. Exercise induced wheeze was detected in 2.3% of the 6-7year old group compared to 15.3% of the 13-14 year olds. Nocturnal cough was more prevalent among 13-14 year olds (18.4%) compared to only 7.2% in the 6-7 year olds. Overall, no significant change in prevalence of asthma symptoms has occurred since 1997 (the last phase of ISAAC) among children of Tehran. The results of our study suggest higher rates of confirmed asthma among 6-7 years old girls compared to boys. However, more extensive and precisely designed studies are needed to further confirm these findings.

Primary immunodeficiencies (PID) are a group of disorders, characterized by an unusual susceptibility to infections. Delay in diagnosis results in increased morbidity and mortality in affected patients. The purpose of this study was to determine the mortality rate of Iranian immunodeficient patients referred to Children Medical Center Hospital affiliated to Tehran University of Medical Sciences over a period of 20 years.In this study, records of 235 (146 males, 89 females) patients with immunodeficiency who were diagnosed and followed in our center, during 22 years period (1979-2001) were reviewed. The diagnosis of immunodeficiency was based on the standard criteria. The cause of death was determined by review of death certificates.Antibody deficiency was the most common diagnosis made in our patients. The overall five-year survival rate was 22.7% in our studied patient group; this was greatest in antibody deficiency. During the 22 year period of study, 32 patients died. As some of the patients could not be located, the true mortality rate ranged between 13.6% and 17.5%. The main leading cause of death were lower respiratory tract involvement in 14 cases (44%). The most common pathogenic microorganisms causing fatal infections were psudomonas and staphylococcus in 9 cases (28.1%) followed by E. coli in 7 (21.9%), tuberculosis in 13 (40.6%) and salmonella in 1 (3.1%).Based on our study, delay in diagnosis in patients with PID results in tissue and organ damage and several complications. Mortality and morbidity are increased in undiagnosed patients.

Cyclic neutropenia is a rare immunodeficiency syndrome, characterized by regular periodic oscillations in the circulating neutrophil count from normal to neutropenic levels through 3 weeks period, and lasting for 3-6 days. In order to determine the clinical features of cyclic neutropenia, this study was performed. Seven patients with cyclic neutropenia (3 males and 4 females), who experienced neutropenic periods every 3 weeks (5 with severe and 2 with moderate neutropenia), were investigated in this study. They had been referred to Iranian Primary Immunodeficiency Registry during 23 years (1980-2003). The range of patients’ ages was from 7 to 13 years (median 11 years). The median age at the onset of the disease was 12 months (1 month- 2 years) and the median age of diagnosis was 2 (1.5-5) years, with a median diagnosis delay of 1 year (2 months- 5 years). Neutropenia was associated with leukopenia (3 patients), anemia (3 patients), and thrombocytopenia (1 patient). Patients were asymptomatic in healthy phase, but during the episode of neutropenia suffered from aphthous ulcers, abscesses and overwhelming infections. The most commonly occurred manifestations were: otitis media (6 cases), oral ulcers (5 cases), abscesses (4 cases), pneumonia (3 cases), diarrhea (3 cases), oral candidiasis (3 cases), cutaneous infections (2 cases), and periodontitis (2 cases). One of these patients subsequently died because of recurrent infections. Unusual, persistent or severe infections should be the initiating factors to search for an immune deficiency syndrome such as cyclic neutropenia, because a delay in diagnosis may result in chronic infection, irretrievable end-organ damage or even death of the patient.

Churg-Strauss Syndrome (CSS) is a small vessel granulomatous vasculitis that characteristically affects the middle age group and is extremely rare in children. We describe an 8-year-old girl with a prolonged history of cough and eosinophilia that initially was labeled as pulmonary tuberculosis, but after complementary assays, associated with skin biopsy, eosinophilic fibrinoid vasculitis, CSS was eventually diagnosed. In this case, due to her young age and more prevalence of infectious lung diseases in our area, there was a few months delay for correct diagnosis and treatment. After meeting the CSS criteria the appropriate treatment was started and her condition improved.