Iranian Journal of Allergy, Asthma and Immunology
Volume:2 Issue: 4, Dec 2003

Bronchial asthma represents an increased airways responsiveness to various stimulants, leading to reversible obstruction of expiratory flow and chronic inflammatory changes in airways wall. Ketamine has been demonstrated to lower airway resistance and to increase lung compliance in the asthmatic patients. In several studies and case reports it has been used successfully in the management of status asthmaticus, resistant to conventional therapy, but so far no clinical trial has been carried out to support this empirical use of ketamine. For this reason, we designed a prospective observational study.Eleven, 15-40 years old patients, with status asthmaticus whose respiratory failure did not respond to conventional therapy and mechanical ventilation (after 24h), were entered in this study (provided that there were not any contraindications to ketamine use). These patients received ketamine at a loading dose of 1 mg/kg (IV), followed by a continuous infusion of 1 mg/kg/hr for 2h. Peak airway pressure, PaCO2 and PaO2 were measured prior to ketamine administration, 15min after administration and 2h after infusion of ketamine. Mean peak airway pressure and PaCO2 significantly decreased 15min and 2h after administration and infusion of ketamine (p<0.005) and PaO2 significantly increased in these time intervals (p<0.005).Ketamine is a useful and safe drug in the intensive treatment of status asthmaticus. However, ketamine should only be used for asthmatics whose respiratory failure does not respond to standard therapy.

Allergic Rhinitis (AR) is one of the most common allergic disorders of childhood.In order to determine the frequency of AR among school-age children, a cross-sectional study was performed.One thousand, nine hundred and thirty-two children (931 boys and 1001 girls), aged 7-18 years, from 30 systematic randomly selected schools of Tehran, the capital of Iran, were investigated in this study. Screening was made on the basis of the questionnaire according to International Study of Asthma and Allergies in Childhood protocol. Diagnosis was confirmed by history and physical examination.Four hundred and fifty-five (240 boys and 215 girls) out of 1932 screened children had AR (23.5%). Seasonal AR and perennial forms were detected in 329 and 126 cases, respectively. The symptoms of seasonal AR were noted at spring (68.7%), summer (15.8%), and fall and winter (15.5%). The total prevalence of asthma was 3.5% according to questionnaire, which was lower than the prevalence (7.2%) in the AR subjects. The prevalence of cutaneous allergy also was 35.8% in children with AR. The positive history of atopy (AR, asthma, or cutaneous allergy) in the first degree relatives was detected in 47.9% in AR cases. Moreover, the history of contact with animals was positive in 35.4% of cases with AR.AR is common among school-age children in Tehran. Coincidence of AR with asthma or cutaneous allergy is significant. Family history of allergy and history of contact with animals and cockroaches are important risk factors in the incidence of AR.

Allergic rhinitis is an extremely common disease worldwide. Aeroallergens are very often involved in allergic rhinitis and their prevalence may vary in different regions. The causative allergens of allergic rhinitis in our area are unknown.The purpose of this study was to determine the prevalence of skin reactivity to different aeroallergens in patients with allergic rhinitis in the city of Shiraz, Iran.A total of 212 patients who were referred to Motahari Allergy Clinic with chronic rhinitis were subjected to skin prick test (SPT) with a series of common allergenic extracts including grasses, weeds, trees, house dust mites and moulds. One hundred and thirty two subjects (62.2%) had positive SPT to at least one aeroallergen. Male to female ratio was 1.2 and mean age was 18.2 years. The prevalence rates for allergen groups were: pollens (92.4%), mites (22.7%) and moulds (8.3%). Among 122 patients reactive to pollens, 92 (75.4%) showed skin reactivity to weeds, 78 (63.9%) to grasses and 68 (55.7%) to trees. Polysensitization was common, with 75.7% of all sensitized patients being positive to more than one aeroallergen.Pollens are the main sensitizing allergens among patients with allergic rhinitis in Shiraz. This pattern of prevalence was expected based on herbal geography, climate and also found to be compatible with the results from studies carried out in places with the same habitat.

Chediak – Higashi Syndrome (CHS) is a rare, primary Immunodeficiency disorder with an autosomal recessive (AR) inheritance and characterized by recurrent infection, partial occulocutaneous albinism and an accelerated phase.In this report we describe clinical and laboratory findings from 6 CHS patients. Clinical and laboratory information of six patients who were referred to our center during the last 20 years (from 1983 – 2003) were reviewed.Onset age of disease was between 3 months to 10 years. All patients had history of consanguineous parents and two patients were siblings. All patients had oculocutaneous albinism, nystagmus, recurrent infections which included upper and lower respiratory tract (U&LRT) infections, stomatitis, thrush, and skin abscesses and hepatitis. In laboratory findings, all patients had neutropenia and normal immunoglobulins and normal CD3, CD4, CD8and CD19 lymphocyte by flowcytometry and three of the four patients had chemotatic defect. Five patients certainly had giant granule in bone marrow neutrophil and in one patient it was equiovocal. Three patients had an accelerated phase, and for one patient bone marrow transplantation was done that was tolerated well and had been well after 7 years.We emphasize the need for early diagnosis on basis of characteristic facies and diagnostic laboratory examinations and early bone marrow transplantation (BMT) in patients.

Although response to intranasal steroid therapy has been reported in patients with allergic rhinitis, efficacy of some nasal steroids is noteworthy.This study was undertaken to evaluate the efficacy of a two-week course of Fluticasone (Flixonase) nasal spray vs. Beclomethasone (beconase) nasal spray in patients with symptoms of allergic rhinitis referred to our clinic. This study reviewed sixty randomized studies with symptoms of allergic rhinitis which supported common aeroallergens with skin prick test. Patients received a total daily dose of nasal spray of Fluticasone (Flixonase) 100 mcg bid (N=30) compared with patients with allergic rhinitis who received a total daily dose of Beclomethasone (Beconase) 50mcg 2 puffs bid (N=30). Patients were visited before and after therapy, and efficacy of Flixonase and Beconase was evaluated by the change in nasal symptoms including: nasal discharge, nasal obstruction, nasal itching, and sneezing. After two weeks of treatment nasal symptoms of blockage, discharge, sneezing and itching were significantly better in the group treated with Fluticasone nasal spray (65%, 82%, 67%, 79% respectively (p<0.001) but after treatment with beconase nasal spray lower benefits in the nasal symptoms includes: 50%, 71%, 51%, 57% respectively. After two weeks of treatment no deleterious changes consequent to therapy were observed in nasal symptoms. 100 mcg bid Flixonase (Fluticasone) intranasal spray is more effective than 50 mcg 2 puffs bid Beconase (Beclomethasone) intranasal spray. Like asthma, allergic rhinitis is an inflammatory disease and should be managed with anti-inflammatory medication.

A random 12 mers phage library was used to screen a pool of immunoglobulin fractions obtained from vitiligo patients. Subsequent to panning experiments, a panel of affinity selected phage from vitiligo patients were obtained. This panel was tested using an ELISA for their reactivity with pooled sera from patients and normal controls. Among the 16 randomly selected clones, two of clones showed distinct positive reactivity with the patient’s sera compared with controls. The peptides displayed by these phages expressed the following amino acid sequences: SHMPLANQYQWA and NHVQAWEQFWDS. Thus, screening with phagedisplayed random peptide library of vitiligo sera can reveal peptide sequences that mimic vitiligo-related self-antigen.

Regulation of normal cell growth and turnover is balanced between cell proliferation, cell differentiation and apoptosis.A disruption of this balance is thought to be an important event leading to carcinogenesis. One of the effector molecules in apoptosis is Fas antigen. Crosslinking of Fas by its ligand (Fas L) or agonistic anti Fas antibodies induces apoptosis of cells expressing Fas on the membrane by triggering cascade of caspaces.The aim of this research was to study the percent of expression of Fas antigen on bone marrow and peripheral blood cells in 100 patients suffering from acute lymphoid and myeloid leukemia by flow cytometry method. Sample were obtained at the time of diagnosis before antileukemic therapy. Expression of Fas antigen on normal control peripheral leukocytes was also analysed.From these data, it was found that Fas antigen is expressed in all cases, but the expression level varied widely.The percentage of Fas antigen expression in all of acute lymphoid leukemia samples was below 20%, but in acute myeloid leukemia samples, 8 out of 50 cases was above 20%. In normal control samples, the mean value for monocytes was higher than granulocytes and in granulocytes higher than lymphcytes.Expression of Fas antigen in most of the leukemic cells was low and the preliminary results showed that increase in Fas antigen expression above 20% after treatment, is a favorable prognostic sign associated with increase relapse free and total survival. Thus evaluation of this antigen before, during and after treatment is recommended.

Nitric oxide (NO) derived from activated macrophages has been shown to be crucial for the host’s leishmanicidal activities. Excess NO, however, can induce apoptosis in some cell types, including macrophages. In the present investigation, we studied the role of NO in inducing apoptosis of BALB/c mice macrophages infected with Leishmania major in vitro. The peritoneal macrophages were harvested and cultured with or without L.major in the presence of a donating reagent (s-Nitroso-N-Acetylpenicillamine (SNAP)) or an inhibitor of NO synthase (NG –Methyl-L-Arginine (NMMA)). The concentration of NO in culture supernatants was measured after 18 hours incubation. Simultaneously, macrophages undergoing apoptosis were identified by fluorescence and electron microscopy. The results showed an increase in apoptosis rate in parallel to nitrite production in macrophages cultured in the presence of SNAP. Although macrophages infected with L.major had no significant increase in NO production, they showed a significant increase in apoptosis rate. Besides, macrophages cultured with NMMA, had a decreased NO production but the apoptosis rate increased. Therefore, mechanisms involved in apoptosis induction in the last two groups may be different from NO overproduction.