Iranian Journal of Allergy, Asthma and Immunology
Volume:4 Issue: 4, Dec 2005

Mycophenolate Mofetil (MMF) has been registered for use in Australia since 1997 for prophylaxis of solid organ allograft rejection. MMF is now increasingly used for indications outside solid organ allograft rejection, often with limited supporting efficacy data. The purpose of this audit was to examine the patterns of use, reported side effects and cost impact of the drug in the Clinical and Immunology and Allergy (CIA) unit of Australia’s largest teaching hospital. Prescription patterns for MMF by consultant immunologists at Westmead hospital between 2000 and 2004 were obtained from the pharmacy. These data were sorted for non-S100 indications. A single immunologist then reviewed the patient files. We also reviewed the literature on the use of this promising immunosuppressant. There has been a marked increase in use of MMF since year 2000 by the Department of CIA. A total of 75 patients were prescribed MMF for non-S100 indications. Common indications were systemic lupus erythematosus, pemphigus vulgaris, chronic idiopathic urticaria, myasthenia gravis, polymyositis, atopic dermatitis, Sjögren’s disease, uveitis and vasculitis. It is clear that MMF has potential for use in a number of immunological disorders because of its relatively benign side effect profile and observed efficacy. Double blinded, placebo-controlled, multicentre trials are necessary to establish its therapeutic role. Our study highlights some of the conditions for which this agent is useful.

The most frequently mutated tumor suppressor gene found in human cancer is p53. In a normal situation, p53 is activated upon the induction of DNA damage to either arrest the cell cycle or else induce apoptosis. However, when mutated, p53 is no longer able to properly accomplish these functions. Our aim was to investigate p53 protein alteration in cases of basal cell carcinoma (BCC) and compare it with the control group. We investigated P53 gene expression in 41 cases of basal cell carcinoma and 20 patients with benign skin disease as control group. The alteration of p53 protein was investigated by immunohistochemistry method. The Data were analyzed using SPSS package, T and Chi-Square tests.Twenty eight out of 41 basal cell carcinoma and 3 out of 20 control were p53-mutated, and there was a statistically significant difference in cases of BCC in comparison with controls (c2 test; p= 0.0001).Taken together, showing alteration of p53 protein, our findings could add to the knowledge that might contribute to the self-maintenance of cancer cells and development of basal cell carcinoma.

Apoptosis, or active cell death, is a specific mode of cell death, which is characterized by morphological changes such as chromatin condensation, fragmentation of the nucleus, cytoplasmic retraction and appearance of apoptotic bodies'' containing apparently intact organelles. Apoptosis occurs in physiological conditions as a regulatory mechanism of tissue growth, where cell proliferation is balanced. The aim of this research was to study the ability of Fas to initiate apoptosis in vitro before and after treatment with Cytarabin on tissue culture and to correlate the response. The human leukemia and normal cells were treated with cytarabin in tissue culture, and apoptotic treated cells were estimated by flow cytometry and phosphatidylserines kit. The results were analyzed by statistical tests (post hoc). From these data, it was found that Fas antigen was expressed in all cases, but the expression level varied widely. Apoptosis and also Fas antigen expression in short term cell culture were higher in media containing drug than in media without drug; but there had been no reasonable correlation between percentage of Fas antigen and apoptosis responses before culture.Expression of Fas antigen was low in most of the leukemic cells and the preliminary results showed that increase in Fas antigen expression (above 20%) after treatment, was a favorable prognostic outcome. It is associated with increase relapse, free and total survival. In addition, using this antigen as a chemotherapic and immunotherapic target, would initiate a new strategy for treatment of leukemia (chemotherapy and immunotherapy).

The prevalence of both obesity and asthma has increased in recent years. Thus we decided to investigate the relation between obesity and asthma severity. We undertook a cross-sectional study in outpatient asthma clinics of 2 tertiary hospitals in Tehran. Obesity was defined as a body mass index greater than 30. Asthma severity was defined by using the Guide for Asthma Management and Prevention 2004 guidelines, according to patients’ clinical and/or spirometerical parameters. Active cigarette smoking patients and patients with a history of other lung diseases were excluded.A total of 116 individuals, aged 16-83 years with a mean age of 46.57±15.05 years, met the entry criteria. There were 73 females and 43 males. The prevalence of obesity in our study population was 29.3%. The Spearman correlation coefficient between asthma severity and body mass index was r= 0.275 (p= 0.001). Mean body mass index of females and males were 28.95±5.41 and 25.17±4.17, respectively. Mean body mass index of females with asthma was significantly higher than males (p< 0.0001). The odds ratios for obesity were 8.650, 8.746, and 22.491 for mild, moderate and severe persistent asthma, respectively, compared to patients with mild intermittent asthma.With increasing asthma severity, we observed higher occurrence of obesity in adults. The association of asthma severity with obesity suggests that obesity may be a potentially modifiable risk factor for asthma or asthma exacerbation.

The prevalence of atopic disease in recent decades has been dramatically increased. It has been suggested that BCG vaccination may protect against development of allergic diseases.The purpose of this study was to identifying relation between scar of BCG vaccine and atopy. This cross-sectional study was done in 1000 children, 10-15 years of age, in Zanjan city. One thousand children (501 girls and 499 boys) were recruited in this study, 137, 121 and 141 cases of asthma, atopic dermatitis and allergic rhinitis, respectively were detected.Three hundred and three subjects had at least one of these disorders, which were diagnosed as atopy. There was reverse correlation between BCG scar and asthma (P=0.013), atopic dermatitis (P<0.01), and atopy (P<0.01). We did not find any association between the diameter of BCG scar and allergic rhinitis. Reverse correlation of asthma, atopic dermatitis and atopy with BCG scar are significant. This relied on history and symptoms of patients. Further studies with skin tests, measurements of total and specific IgE levels and spirometery are recommended.

The aim of this study was identification of fungi in indoor and outdoor of asthmatic patients´ home environment. Opened plates (containing of Malt extract agar media) were used for isolation of fungi in the air of indoor (n=360) and outdoor (n=180) of 90 asthmatic patients̉ home living in the city of Sari at the level of breathing height. Plates were incubated in room temperature for 7-14 days. Then grown fungi were identified by standard mycological techniques.A total of 1876 colonies with 31 and 1692 colonies with 27 genera of fungi were identified from indoor and outdoor of asthmatic patients’ home respectively. The most common fungi isolated were Cladosporium, Aspergillus and Penicillium. Stachibotyris, Oedocephalum, and Stemphillium showed the least frequencies among the isolated fungi.Cladosporium, Aspergillus, Penicillium, and Alternaria as the most common allergenic moulds had the most frequencies in indoor air of the houses of asthmatic patients.

We present a case of allergic fungal sinusitis (AFB) in a 20-year old man with few months'' history of bilateral nasal obstruction and discharge with unilateral proptosis that underwent maxillary antrostomy due to the mass in paranasal sinuses. Histological examination of tissue showed branching fungal hyphae interspersed with allergic mucin without fungal invasion to soft tissue. The patient received local steroid for 4 months and had no problem during follow up. Fungal culture was performed and Bipolaris fungus grew. Although most dematiaceous fungal infections occur in immunocompetent patients, the incorrect diagnosis and insufficient treatment may be life threatening.

Autoimmune lymphoproliferative syndrome (ALPS) is a prototypic disorder of abnormal lymphocyte homeostasis. In the September 2005 issue of The Iranian Journal of Allergy, Asthma and Immunology, a patient with clinical features consistent with ALPS was described. Although the clinical presentation was in favor of ALPS, a precise diagnosis needed more laboratory evaluations