Hypersensitivity
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Early-Phase GVHD Gene Expression Profile in Target Versus Non
Bone Marrow Transplantation (2013) 48, 284–293 & 2013 Macmillan Publishers Limited All rights reserved 0268-3369/13 www.nature.com/bmt ORIGINAL ARTICLE Early-phase GVHD gene expression profile in target versus non-target tissues: kidney, a possible target? B Sadeghi1, H Al-Chaqmaqchi1, S Al-Hashmi1, D Brodin2, Z Hassan1,3, M Abedi-Valugerdi4, A Moshfegh5 and M Hassan1,3 GVHD is a major complication after allo-SCT. In GVHD, some tissues like liver, intestine and skin are infiltrated by donor T cells while others like muscle are not. The mechanism underlying targeted tropism of donor T cells is not fully understood. In the present study, we aim to explore differences in gene expression profile among target versus non-target tissues in a mouse model of GVHD based on chemotherapy conditioning. Expression levels of JAK–signal transducers and activators of transcription (STAT), CXCL1, ICAM1 and STAT3 were increased in the liver and remained unchanged (or decreased) in the muscle and kidney after conditioning. At the start of GVHD the expression levels of CXCL9, ITGb2, SAA3, MARCO, TLR and VCAM1 were significantly higher in the liver or kidney compared with the muscle of GVHD animals. Moreover, biological processes of inflammatory reactions, leukocyte migration, response to bacterium and chemotaxis followed the same pattern. Our data show that both chemotherapy and allogenicity exclusively induce expression of inflammatory genes in target tissues. Moreover, gene expression profile and histopathological findings in the kidney are similar to those observed in the liver of GVHD mice. Bone Marrow Transplantation (2013) 48, 284–293; doi:10.1038/bmt.2012.120; published online 23 July 2012 Keywords: gene expression; GVHD; kidney; target tissues; mouse model INTRODUCTION none of these reports describe any changes in gene expression Allo-SCT is the treatment of choice for a variety of malignant and profile of non-target tissues like muscle. -
Food Allergy Outline
Allergy Evaluation-What it all Means & Role of Allergist Sai R. Nimmagadda, M.D.. Associated Allergists and Asthma Specialists Ltd. Clinical Assistant Professor Of Pediatrics Northwestern University Chicago, Illinois Objectives of Presentation • Discuss the different options for allergy evaluation. – Skin tests – Immunocap Testing • Understand the results of Allergy testing in various allergic diseases. • Briefly Understand what an Allergist Does Common Allergic Diseases Seen in the Primary Care Office • Atopic Dermatitis/Eczema • Food Allergy • Allergic Rhinitis • Allergic Asthma • Allergic GI Diseases Factors that Influence Allergies Development and Expression Host Factors Environmental Factors . Genetic Indoor allergens - Atopy Outdoor allergens - Airway hyper Occupational sensitizers responsiveness Tobacco smoke . Gender Air Pollution . Obesity Respiratory Infections Diet © Global Initiative for Asthma Why Perform Allergy Testing? – Confirm Allergens and answer specific questions. • Am I allergic to my dog? • Do I have a milk allergy? • Have I outgrown my allergy? • Do I need medications? • Am I penicillin allergic? • Do I have a bee sting allergy Tests Performed in the Diagnostic Allergy Laboratory • Allergen-specific IgE (over 200 allergen extracts) – Pollen (weeds, grasses, trees), – Epidermal, dust mites, molds, – Foods, – Venoms, – Drugs, – Occupational allergens (e.g., natural rubber latex) • Total Serum IgE (anti-IgE; ABPA) • Multi-allergen screen for IgE antibody Diagnostic Allergy Testing Serological Confirmation of Sensitization History of RAST Testing • RAST (radioallergosorbent test) invented and marketed in 1974 • The suspected allergen is bound to an insoluble material and the patient's serum is added • If the serum contains antibodies to the allergen, those antibodies will bind to the allergen • Radiolabeled anti-human IgE antibody is added where it binds to those IgE antibodies already bound to the insoluble material • The unbound anti-human IgE antibodies are washed away. -
Allergic Reactions After Vaccination: Translating Guidelines Into Clinical Practice
R E V I E W EUR ANN ALLERGY CLIN IMMUNOL VOL 51, N 2, 51-61, 2019 A. RADICE1, G. CARLI2, D. MACCHIA1, A. FARSI2 Allergic reactions after vaccination: translating guidelines into clinical practice 1SOS Allergologia e Immunologia, Firenze, Azienda USL Toscana Centro, Italy 2SOS Allergologia e Immunologia, Prato, Azienda USL Toscana Centro, Italy KEYWORDS Summary vaccine; vaccination; allergic reactions; Vaccination represents one of the most powerful medical interventions on global health. anaphylaxis; vaccine hesitancy; vaccine Despite being safe, sustainable, and effective against infectious and in some cases also components; desensitization non-infectious diseases, it’s nowadays facing general opinion’s hesitancy because of a false perceived risk of adverse events. Adverse reactions to vaccines are relatively rare, instead, and those recognizing a hypersensitivity mechanism are even rarer. Corresponding author The purpose of this review is to offer a practical approach to adverse events after vaccina- Anna Radice Ospedale San Giovanni di Dio tion, focusing on immune-mediated reactions with particular regard to their recognition, Via Torregalli 3, 50143 Firenze diagnosis and management. Phone: +39 055 6932304 According to clinical features, we propose an algorythm for allergologic work-up, which E-mail: [email protected] helps in confirming hypersensitivity to vaccine, nonetheless ensuring access to vaccination. Finally, a screening questionnaire is included, providing criteria for immunisation in spe- Doi cialized care settings. 10.23822/EurAnnACI.1764-1489.86 Introduction The gain from vaccination is not just about human health, but it is also a matter of financial resources for health systems. “Smallpox is dead” stated the magazine of the World Health It has been calculated that for every dollar spent in vaccines, Organisation (WHO) in 1980. -
Ige – the Main Player of Food Allergy
DDMOD-431; No of Pages 8 Vol. xxx, No. xx 2016 Drug Discovery Today: Disease Models Editors-in-Chief Jan Tornell – AstraZeneca, Sweden DRUG DISCOVERY Andrew McCulloch – University of California, SanDiego, USA TODAY DISEASE MODELS IgE – the main player of food allergy 1 2,3 2 Henrike C.H. Broekman , Thomas Eiwegger , Julia Upton , 4, Katrine L. Bøgh * 1 Department of Dermatology/Allergology, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands 2 Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, The Department of Paediatrics, Hospital for Sick Children, Toronto, Canada 3 Research Institute, Physiology and Experimental Medicine, The University of Toronto, Toronto, Canada 4 National Food Institute, Technical University of Denmark, Søborg, Denmark Food allergy is a growing problem worldwide, presently Section editor: affecting 2–4% of adults and 5–8% of young children. IgE Michelle Epstein – Medical University of Vienna, is a key player in food allergy. Consequently huge Department of Dermatology, DIAID, Experimental Allergy, Waehringer Guertel 18-20, Room 4P9.02, A1090, efforts have been made to develop tests to detect Vienna, Austria. either the presence of IgE molecules, their allergen binding sites or their functionality, in order to provide allergen ingestion [1], and involve one or more of the follow- information regarding the patient’s food allergy. The ing systems; the skin (pruritus, urticaria, or angioedema), the ultimate goal is to develop tools that are capable of gastro-intestinal tract (diarrhea, vomiting, contractions, in- creased bowel movement), the respiratory tract (asthma at- discriminating between asymptomatic sensitization tack, hoarseness, stridor/laryngeal angioedema) or the and a clinically relevant food allergy, and between cardiovascular system (dizziness, drop in blood pressure, loss different allergic phenotypes in an accurate and trust- of consciousness) [2,3]. -
Introduction to Bacteriology and Bacterial Structure/Function
INTRODUCTION TO BACTERIOLOGY AND BACTERIAL STRUCTURE/FUNCTION LEARNING OBJECTIVES To describe historical landmarks of medical microbiology To describe Koch’s Postulates To describe the characteristic structures and chemical nature of cellular constituents that distinguish eukaryotic and prokaryotic cells To describe chemical, structural, and functional components of the bacterial cytoplasmic and outer membranes, cell wall and surface appendages To name the general structures, and polymers that make up bacterial cell walls To explain the differences between gram negative and gram positive cells To describe the chemical composition, function and serological classification as H antigen of bacterial flagella and how they differ from flagella of eucaryotic cells To describe the chemical composition and function of pili To explain the unique chemical composition of bacterial spores To list medically relevant bacteria that form spores To explain the function of spores in terms of chemical and heat resistance To describe characteristics of different types of membrane transport To describe the exact cellular location and serological classification as O antigen of Lipopolysaccharide (LPS) To explain how the structure of LPS confers antigenic specificity and toxicity To describe the exact cellular location of Lipid A To explain the term endotoxin in terms of its chemical composition and location in bacterial cells INTRODUCTION TO BACTERIOLOGY 1. Two main threads in the history of bacteriology: 1) the natural history of bacteria and 2) the contagious nature of infectious diseases, were united in the latter half of the 19th century. During that period many of the bacteria that cause human disease were identified and characterized. 2. Individual bacteria were first observed microscopically by Antony van Leeuwenhoek at the end of the 17th century. -
Difference Between Hypersensitivity and Autoimmunity Key Difference – Hypersensitivity Vs Autoimmunity
Difference Between Hypersensitivity and Autoimmunity www.differencebetwee.com Key Difference – Hypersensitivity vs Autoimmunity Autoimmunity is an adaptive immune response mounted against self-antigens. In simple terms, when your body is acting against its own cells and tissues, this is called an autoimmune reaction. An exaggerated and inappropriate immune response to an antigenic stimulus is defined as a hypersensitivity reaction. Unlike autoimmune reactions that are triggered only by the endogenous antigens, hypersensitivity reactions are triggered by both endogenous and exogenous antigens. This is the key difference between hypersensitivity and autoimmunity. What is Hypersensitivity? An exaggerated and inappropriate immune response to an antigenic stimulus is defined as a hypersensitivity reaction. The first exposure to a particular antigen activates the immune system and, antibodies are produced as a result. This is called sensitization. Subsequent exposures to the same antigen give rise to hypersensitivity. Few important facts regarding the hypersensitivity reactions are given below They can be elicited by both exogenous and endogenous agents. They are a result of an imbalance between the effector mechanisms and the countermeasures that are there to control any inappropriate execution of an immune response. The presence of a genetic susceptibility increases the likelihood of hypersensitivity reactions. The manner in which hypersensitivity reactions harm our body is similar to the way that the pathogens are destroyed by immune reactions. Figure 01: Allergy According to the Coombs and Gell classification, there are four main types of hypersensitivity reactions. Type I- Immediate Type/ Anaphylactic Mechanism Vasodilation, edema, and contraction of smooth muscles are the pathological changes that take place during the immediate phase of the reaction. -
RAST Type Tests CPT: 86003
Medicare Local Coverage Determination Policy Allergy Testing RAST Type Tests CPT: 86003 Medically Supportive CMS Policy for Kentucky and Ohio ICD Codes are listed Local policies are determined by the performing test location. This is determined by the state on subsequent page(s) in which your performing laboratory resides and where your testing is commonly performed. of this document. Coverage Indications, Limitations, and/or Medical Necessity Radioallergosorbent test (RAST), fluoroallergosorbent test (FAST), and multiple antigen simultaneous tests are in vitro techniques for Add full policy information determining whether a patient's serum contains IgE antibodies against specific allergens of clinical importance. As with any allergy testing, the need for such tests is based on the findings during a complete history and physical examination of the patient. The multiple antigen simultaneous testing technique is similar to the RAST/FAST techniques in that it depends upon the existence of Template structure: allergic antibodies in the blood of the patient being tested. With the multiple antigen simultaneous test system, several antigens may be used to test for specific IgE simultaneously. First level is for headers such as limitations, ELISA (enzyme-linked immunosorbent assay) is another in vitro method of allergy testing for specific IgE antibodies against allergens. indications and usage guidelines This method is also a variation of RAST. Second level is for main body copy Limitations • Third level is for bullet (if needed) The following tests are considered to be not medically necessary and will be denied. • ELISA/Act qualitative antibody testing. This testing is used to determine in vitro reaction to various foods and relies on lymphocyte blastogenesis in response to certain food antigens. -
Ii Vasclitides
ا يمون وپات وژنز واسکوليتھااکلتا Vascliiitides: The Immunopa tho genes is دکتر محمدمھدی محمدی LMD, PhD, MPH ([email protected]) The 7th International 12th National Congress on Quality Improvement in Clinical Laboratories 28 Farvardin 1393 / 17April 2014 , Tehran, Iran A small spoonful of Terminology (in Farsi بيماريزايی) – .path·o·gen·e·sis, n • – the ppp(roduction and development of disease (events and reactions and other pathologic mechanisms) . Also, pa·thog·e·ny !?! (in Farsi بيماريزايی) _ .path·o·ge·nic·i·ty, n • – the disease-producing capacity of a pathogen. [PATHOGENIC + -ITY] • vir·u·lence, n. – the relative ability of a microorganism to cause disease; degree of pathogenicity. • Vasculitis, n. (vasculitides, plural) – a general term for vessel wall inflammation, systemic or localized, immune-mediated or directly invaded by microbes. • Infections may indirectly generate vasculitis, e.g. through IC formation or by X_reaction. Note that immunosuppressive therapy is only appropriate for --?– type! • WHAT R the IMMUNE MECHANISMS in VASCULITIS? افراط تعادل تفريط Immunodeficiency Allergy (& Infection) Defence Immunodeficiency Surveillance Autoimmunity (& Malignancy) Homostasis ?! Some Inter-related Concepts Immunological Vasculitis Hypersensitivity Auoimmunity Tolerance EDUCATION? Tolerance in different classic Txtbks of Immunology (Abbas, Benjamini, Janeway, Kuby, Roitt, Stites …) • Tolerance (by C&M Immunology): – Unresponsiveness of the adaptive immune system to antigens, as a result of inactivation or death of antigen-specific lymphocytes, induced by exposure to the antigens. – (()Active) Unresponsiveness of the (()HEALTHY) adappytive immune system to (selected) antigens, as a result of (i.e. MECHANISMS:) inactivation or death of antigen-specific lymphocytes, induced by exposure to those antigens. • Tolerance to self antigens is a normal feature of the adaptive immune system, but tolerance to foreign antigens may be induced undtiditiftider certain conditions of antigen exposure. -
Role of Serologic Testing in Rheumatic Diseases
Role of Serologic Testing in Rheumatic Diseases Debendra Pattanaik MD FACP Associate professor of Medicine UTHSC, Memphis TN Disclosure None Objectives Discuss commonly available serologic testing useful in daily clinical practice Recognize the serologic associations of rheumatic diseases Recognize their diagnostic utilities and limitations Diagnostic Accuracy for Lupus and other autoimmune diseases in the community setting 476 patients were evaluated at Autoimmunity Center of University of Florida, Gainesville for 13 months which were by from primary care physicians SLE was over diagnosed on many patients on the basis of + ANA 39 patients are taking prednisone 60 mg/day who have no autoimmune disease but only have + ANA Inappropriate diagnosis leads to inappropriate therapy, emotional and financial consequences The authors suggested continuing education in screening for autoimmune disease and identify patients who may benefit from early referral. Arch Intern Med. 2004;164:2435-2441 Antinuclear Antibody (ANA) Testing for Connective Tissue Disease British Columbia Population: 4.631 million. More than 94,000 ANA tests were performed in B.C. in fiscal year 2011/12 at a cost of $2.24 million annually. Incidence and Estimated New Cases in B.C. for Selected CTDs Connective Tissue Disease Disease incidence per million population Estimated new BC cases/year * Systemic lupus erythematosus 56 259 Scleroderma 19 88 Dermatomyositis & polymyositis < 10 < 46 Eighteen percent of first-time tested outpatients underwent unnecessary repeat testing in 2010/2011. In 57.2% of the repeat testing, both the initial and the repeat ANA tests were ordered by a GP. In 24.8% the initial test was ordered by a GP and the repeat test was ordered by a specialist, and in 10.2% both the initial and the repeat test were ordered by the same specialist. -
Drug Allergies: an Epidemic of Over-Diagnosis
Drug Allergies: An Epidemic of Over-diagnosis Donald D. Stevenson MD Senior Consultant Div of Allergy, Asthma and Immunology Scripps Clinic Learning objectives • Classification of drug induced adverse reactions vs hypersensitivity reactions • Patient reports of drug induced reactions grossly overstate the true prevalence • The 2 most commonly recorded drug “allergies”: NSAIDs and Penicillin • Accurate diagnoses of drug allergies • Consequences of falsely identifying a drug as causing allergic reactions Classification of Drug Associated Events • Type A: Events occur in most normal humans, given sufficient dose and duration of therapy (85-90%) – Overdose Barbiturates, morphine, cocaine, Tylenol – Side effects ASA in high enough doses induces tinnitus – Indirect effects Alteration of microbiota (antibiotics) – Drug interactions Increased blood levels digoxin (Erythromycin) • Type B: Drug reactions are restricted to a small subset of the general population (10-15%) where patients respond abnormally to pharmacologic doses of the drug – Intolerance: Gastritis sometimes bleeding from NSAIDs – Hypersensitivity: Non-immune mediated (NSAIDs, RCM) – Hypersensitivity: Immune mediated (NSAIDs, Penicillins ) Celik G, Pichler WJ, Adkinson Jr NF Drug Allergy Chap 68 Middleton’s Allergy: Principles and Practice, 7th Ed, Elsevier Inc. 2009; pg 1206 1206. Immunopathologic (Allergic) reactions to drugs (antigens): Sensitization followed by re-exposure to same drug antigen triggering reaction Type I Immediate Hypersensitivity IgE Mediated Skin testing followed -
Food Fact Sheet: Food Allergy and Food Intolerance
Food Fact Sheet: Food Allergy and Food Intolerance Having to avoid certain foods in your diet can be difficult. But there are a few simple things you can do to help you manage your food allergies - allowing you to stay safe, continue to participate in fun activities and enjoy your food. What is the difference between food allergy and food intolerance? For some people, eating certain foods can lead to an unpleasant and sometimes dangerous physical reaction. The term used to describe all types of reactions to foods is ‘food hypersensitivity’. A 'food allergy' is a reaction involving the immune system (the body’s defence against foreign bodies). Those that do not involve the immune system are often called a ‘food intolerance’. It is important to identify and manage foods that trigger any symptoms in an appropriate way. Food allergy Proteins within foods can trigger immediate (within two hours) or delayed symptoms (up to several days later). Immediate food allergy (IgE mediated food allergy) Immediate reactions to foods occur when your immune system reacts to a normally harmless protein in food, due to the creation of Immunoglobulin E (IgE). This results in the release of chemicals (e.g. histamine) which trigger allergic symptoms. These symptoms are usually in the skin (itching/swelling), or gut (vomiting, diarrhoea). Other symptoms can include breathing problems and in rare cases an extreme allergic reaction called anaphylaxis. Delayed food allergy (non IgE mediated food allergy) Delayed reactions to foods still involve your immune system, but there is a different type of immune reaction involved. Symptoms typically occur in the gut (vomiting, diarrhoea, constipation) and/or the skin (atopic eczema). -
Allergy, Hypersensitivity, Angioedema, and Anaphylaxis Episode Overview
CrackCast Show Notes –Allergy and Anaphylaxis – October 2017 www.canadiem.org/crackcast Chapter 109 – Allergy, Hypersensitivity, Angioedema, and Anaphylaxis Episode Overview Key Points: 1. A history of sudden urticarial rash accompanied by respiratory difficulty, abdominal pain, or hypotension, strongly favors the diagnosis of anaphylaxis. 2. Epinephrine is the first-line treatment in patients with anaphylaxis: give it immediately. 3. There are no absolute contraindications to the use of epinephrine in the setting of anaphylaxis. 4. Antihistamines and corticosteroids are second- and third-line agents in the management of anaphylaxis and should not replace or precede epinephrine. 5. Consider prolonged observation or admission for patients who: a. Experience protracted anaphylaxis, hypotension, or airway involvement; b. Receive IV epinephrine or more than two doses of IM epinephrine; c. Or have poor outpatient social support. 6. Patients discharged after an anaphylactic event should be prescribed an EpiPen and instructed on its use. 7. Patients with refractory hypotension may require glucagon (receiving beta-blockage) or a continuous IV epinephrine infusion. 8. Non-histaminergic angioedema (non-allergic angioedema) does not typically respond to epinephrine and antihistamines. New drugs, including berinert, icatibant, ecallantide, and Ruconest have been approved for use in HAE. FFP has been used with varying success in HAE, ACID, and ACE inhibitor–induced angioedema. NOTE: ACID: acquired C1 esterase deficiency (ACED) Core Questions: 1. List the four types of Gell and Coombs classifications of immune reaction and give examples of each 2. List four etiologic agents causing anaphylaxis by immunologic mechanisms 3. List six mediators of anaphylaxis and their physiologic actions and clinical manifestations 4.