Iranian Journal of Allergy, Asthma and Immunology
Volume:9 Issue: 4, Dec 2010

Autoimmunity and viral infections are closely associated fields, and viruses have been proposed as a likely aetiological, contributory or triggering factors of systemic autoimmune diseases. Hepatitis C virus seems to be the virus usually associated with the appearance of autoimmune diseases, and the relationship between chronic hepatitis C virus infection and some autoimmune disease has been studied. For some of these disorders their association with hepatitis C virus infection is well recognized while for others it remains probable or weak. Examples of autoimmune phenomena observed in chronic hepatitis C virus infection include rheumatoid arthritis, thyroid disease, cryoglobulinaemia, immune thrombocytopenic purpura, systemic lupus erythematosus and sjogren syndrome. To date, the etiological role and the pathogenetic involvement of the hepatitis C infection remains unknown.The aim of this study is to assess the presence of different autoimmune manifestations of hepatitis C virus infection reported in literature.

Allergic airway inflammation is characterized by elaboration of cytokines and chemokines leading to recruitment of inflammatory leukocytes, predominantly eosinophils, to the airways. Granulocyte macrophage colony stimulating factor (GM-CSF) is generated in the lungs of human subjects with asthma in response to allergen challenge and is necessary for the development of allergen-induced bronchial eosinophilia in mice. The effect of GM-CSF on human eosinophil and neutrophil interactions with the vascular endothelium under conditions of blood flow was investigated in post-capillary venules of the rabbit mesentery by intravital microscopy.While GM-CSF significantly reduced the rolling fraction of neutrophils in vivo and induced consistent shedding of neutrophil L-selectin in vitro, its effect on eosinophil rolling was variable. Eosinophils from 57% of the donors demonstrated inhibition of rolling, while eosinophils from the remaining 43% of donors demonstrated no inhibition or increased rolling. The variable effect of GM-CSF on inhibition of eosinophil rolling was associated with variable shedding of L-selectin in vitro. In contrast to the differential effect of GM-CSF on neutrophils versus eosinophils, stimulation with phorbol myristate acetate demonstrated a similar degree of inhibition of rolling and L-selectin shedding by neutrophils and eosinophils suggesting that there was no defect in L-selectin shedding in the eosinophil donors who did not respond to GM-CSF.Overall, these studies demonstrate that GM-CSF consistently inhibits interaction of neutrophils with endothelium in vivo, whereas its effect on eosinophil-endothelial interactions is variable. GM-CSF may thus be one factor accounting for the varying percentage of eosinophils and neutrophils recruited to sites of allergic inflammation in different individuals.=

Multiple sclerosis (MS) is a disease of the central nervous system (CNS) characterized by multiple regions of demyelination and inflammation along axons with a T cell-mediated autoimmune etiology. While the cytotoxic T lymphocyte antigen 4 (CTLA-4) gene seems to be a strong candidate gene in autoimmune diseases, we investigated its association with a group of patients with MS. One hundred and thirty five patients with relapsing-remitting form of MS and 135 healthy subjects were enrolled in this study. Three single nucleotide polymorphisms (SNPs) (-318C/T, +49A/G, +6230A/G) of the CTLA-4 gene were assessed using PCR-RFLP method. The genotypes -318 CC (82.9% in patients vs. 76.2% in controls) and +49 AA (31.1% in patients vs. 28.1% in controls) were overrepresented in the patient group; however, these differences were not statistically significant.In spite of some previous reports, this study did not confirm any significant association with alleles and genotypes of SNPs of the CTLA4 in Iranian MS patients. Such disparity could be due to genetic background, ethnicity and different forms of the disease.

Patients with allergic rhinitis (AR) show increased production of the Th2-related cytokines. Almost always, intranasal corticosteroid (INC) and antihistamine are used as routine therapy of AR. This study was performed to determine the in vitro secretion of cytokines profiles of PBMCs in patients with AR sensitive to Chenopodium album (Ch.a) pollens before and after treatment with INC (Fluticasone propionate) and oral antihistamine (Loratadine). PBMCs of 20 patients with AR, were tested in vitro for cytokine production. These cells were stimulated with natural or recombinant Ch.a. The levels of IL-4, IL-13 and IFN-, were measured in supernatants of cultured cell 96h after stimulation using ELISA. The PBMCs of 20 normal individuals were also similarly treared for comparison of results. The production of IL-4 by the patient's cells stimulated with either Ch.a or rCh.a was significantly higher than normal levels before therapy (p=0.04 and p=0.02, respectively). After therapy, a significant decrease in production of IL-4 and a significant increase in production of IL-10 were found in PBMCs stimulated with natural Ch.a, in comparison to the results before stimulation (p=0.03 for IL-4; p=0.04 for IL-10). Similarly, these results were seen in the production of IL-4 and IL-10 stimulated with rCh.a allergen after therapy in comparison to the results before stimulation (p=0.01 for IL-4; p=0.03 for IL-10). This study suggests INC (Fluticasone propionate) and oral antihistamine (Loratadine) have the capacity to inhibit the production of IL-4 and shift Th2/Th1 responses, probably due to increase the level of immunoregulatory IL-10. Therefore, it could be concluded that therapy with INC and antihistamine has pharmacologic and immunologic therapeutic effects on AR patients.

The relationship between asthma and sinusitis has been proposed in many reports but the role of sinus surgery in their treatment is still controversial. Therefore, the effect of functional sinus surgery in patients with controlled asthma was evaluated. Fifty six patients with a history of sinusitis in whom maximum medical treatment had failed and also those with a history of asthma who were in a stable condition at time of surgery and were candidates for endoscopic sinus surgery were selected. All those who underwent functional endoscopic sinus surgery were re-evaluated at last one year later for pulmonary and sinus status. The patient's characteristics were prospectively recorded during the study period from January 2007 to November 2009. Finally, the results of the assessments were analyzed. Among 56 studied patients, 35 (62.5%) were female and 21 (37.5%) male. Preoperative imaging, evaluated according to Lund Mac Kay score, had a mean score of 19.5±5. The average effect of FESS in asthma improvement was 69.6%. Asthma improvement had a significant relationship with the duration of asthma and sinusitis before surgery. Functional endoscopic sinus surgery can effectively treat sinusitis in asthmatic patients. Earlier intervention in the course of pulmonary disease may warrant a better outcome.

Transient hypogammaglobulinemia (THI) of infancy is a common primary immunodeficiency usually resolves by 3 years of age.In this study, clinical, immunological data and outcome of 101 retrospectively diagnosed THI patients were evaluated. Majority of them suffered from recurrent respiratory infections (70.3%). Initial IgG, IgM and IgA levels were 446.7±121.5, 67.5±32.8, and 25.6±16.8 mg/dl, respectively. Patients who had lower IgG levels on admission reached normal IgG levels earlier than others. Infants who were retarded to reach age-related normal levels for IgM and IgA were found to have higher CD3+CD8+ T cells on admission. During immunoglobulin abnormalities, mean lymphocyte subset percentages and absolute counts were normal. Mean percentage of CD19+CD27+ memory B cells was 3.4±1.4% which is not significantly different from healthy children. Most of the children had protective antibody responses to tetanus (87%) and Haemophilus influenzae type B (85.7%) vaccines. Patients with low anti-tetanus responses had higher initial natural killer (NK) cell percentages probably due to recurrent viral infections or relative dominance of innate responses. Follow-up of patients with initially high NK were found to have longer duration of deficiency hence these patient's recoveries were delayed. During follow-up, 91/101 (90.1%) children produced normali levels of IgG at the end of 29.2 ± 15.2 months. The results of this study indicate that some children will achieve normal levels of IgG within 30 months of age, and some will remain IgG subclass or IgA deficient. Determination of increased NK percentages in patients with non-protective vaccine response and normal percentages of memory B cells are noteworthy novel findings.

The study aimed to assess the prevalence and associated risk factors of immediate-type hypersensitivity reactions (HRs) to drugs in workers.The data consisted of 1152 questionnaires obtained from adult men that consisted of questions on HRs induced by drugs. The prevalence of self-reported drug HRs was 3.6% for all reactions. HRs were most common to beta-lactam antibiotics (51.2%) followed by nonsteroid antiinflammatory drugs (NSAIDs) (41.5%). Multivariate analysis showed that family atopy was associated with drug HRs to both antibiotics (Odds Ratio (OR) 95% Confidence Interval (CI) (3.32 (1.15-9.56)) and NSAIDs (3.70 (1.09-12.51)). Drug HRs of any type were associated with atopic family history (3.23 (1.43-7.24)), ever asthma diagnosis (2.74 (1.07-7.02)), ever allergic rhinitis (2.70 (1.25-5.84)), and ever eczema (3.80 (1.55-9.30)). Drug related skin manifestations were associated with family history of atopic diseases (4.07 (1.76-9.41)), ever allergic rhinitis (2.84 (1.24-6.5)), ever asthma diagnosis (3.16 (1.19-8.39)), and ever eczema diagnosis (4.59 (1.82-11.57)). Systemic manifestations of drug HRs were associated with only asthma diagnosis (4.66 (1.25-17.41)).Risk groups should be followed closely as candidates for immediate type HRs to antibiotics and NSAIDs in also relatively healthy and young aged adult men.

Human metapneumovirus (hMPV) infection plays an important role in the pediatric respiratory infections. The aim of this study was to determine the relationship between asthma and wheezing with hMPV in hospitalized children. Nasal pharyngeal swabs obtained from 120 children aged 1-60 months, hospitalized during a one year period, were tested for the hMPV by RT-PCR. HMPV was detected in 20 (16.6%) of patients suffering from wheezing. Some patients in addition to wheezing had asthma 10.8%. This infection occurred predominantly from October 2008 to September 2009.

case of Mycobacterium Marinum infection of the nasal cavity is described. A 57 years old man was being on Infliximab for 2 years for severe psoriasis presented with five months history of epistaxis, nasal blockage and snoring. Local examination revealed bilateral nasal mass. The diagnosis of mycobacterial infection was suspected based upon the histopathological finding of granuloma in the biopsy specimen, and later confirmed by Mycobacterial culture. The patient was treated with 3 months therapy of Ethambutol and Rifampicin with good clinical response.The clinical presentation of the case is discussed with a review of the literature about current guidelines for prophylaxis and other preventive strategy for infection among patients receiving TNF antagonists.