RESUMEN
SUMMARY: We described a case of a 56 year old homosexual HIV positive man who presented a history of CSU since one year (2012). All the allergologic, immunologic and microbiologic tests to evaluate the pathogenesis of wheals resulted negative. Therefore in June 2015 we decided to start therapy with Omalizumab while the patient kept on effective antiretroviral therapy with 310 cells/mm3 TCD4 counts and undetectable HIV viremia. After two monthly subcutaneuous injection of 150 mg of Omalizumab the patient had no more urticarial symptoms. UAS7 (Urticaria Activity Score over 7 days) and Cu-Q2oL (chronic urticarial quality of life questionnaire) dropped respectively to 14 from 42 and to 0 from 40 with increase of TCD4 counts while viral load remained undetectable. In November 2015, i.e. 4 months after the end of Omalizumab therapy, the patient was still asymptomatic with persistent effective immune-virological response to antiretroviral therapy. This case report confirms the excellent tolerability and efficacy of anti-IgE therapy in the treatment of spontaneous chronic urticarial even in an immunodepressed patient for HIV infection. Omalizumab therapy shows a remarkable clinical success and had no effect on peripheral TCD4 counts and HIV viral load.
Asunto(s)
Antialérgicos/uso terapéutico , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Huésped Inmunocomprometido , Omalizumab/uso terapéutico , Urticaria/tratamiento farmacológico , Recuento de Linfocito CD4 , Enfermedad Crónica , Infecciones por VIH/diagnóstico , Infecciones por VIH/inmunología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Urticaria/diagnóstico , Urticaria/inmunología , Carga ViralRESUMEN
HIV infection is a relative contraindication for allergic immunotherapy (AIT). In the last decade, highly active antiretroviral therapy (HAART) has improved the immune function and life expectancy in HIV-infected patients whose respiratory allergic incidence is similar to the general population. We evaluated the safety and clinical effectiveness of sublingual immunotherapy in a group of grass pollen-allergic HAART-treated HIV-positive patients. Thirteen patients received sublingual immunotherapy (SLIT) tablet (Oralair, Stallergenes©) and symptomatic therapy and were compared with nine patients receiving symptomatic therapy alone. Clinical benefits were evaluated by the analysis of total combined score (TCS), sum of symptom-medication score, and a quality of life (QoL) questionnaire. HIV viral load and peripheral TCD4 lymphocytes were analyzed at the beginning and at the end of the study. Clinical efficacy data showed a significant improvement in SLIT-treated patients compared to controls (TCS: P = 0.0001; QoL: P = 0.03). We did not observe any significant alteration of TCD4 cell counts and viral load (VL) in both groups. Our preliminary data showed that SLIT therapy in viro-immunological controlled HAART treated HIV positive patients was efficacious, safe and well tolerated.
Asunto(s)
Infecciones por VIH/complicaciones , Rinitis Alérgica Estacional/complicaciones , Rinitis Alérgica Estacional/terapia , Inmunoterapia Sublingual , Adulto , Alérgenos/administración & dosificación , Alérgenos/inmunología , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida , Rinitis Alérgica Estacional/epidemiología , Rinitis Alérgica Estacional/inmunología , Inmunoterapia Sublingual/métodosRESUMEN
We described the first case reported in literature of anaphylactic shock after administration of pollen extract vaccine chemically modified (allergoid) adsorbed onto L-Tyrosine depot adjuvanted with monophosphoryl lipid A (Pollinex® Quattro MPL-4).
Asunto(s)
Anafilaxia/inducido químicamente , Lípido A/análogos & derivados , Vacunas/efectos adversos , Humanos , Lípido A/efectos adversos , Masculino , Persona de Mediana EdadRESUMEN
We describe a case of chronic idiopathic urticaria in which symptoms improved dramatically after treatment with omalizumab. This drug, which is approved for the treatment of asthma, has been studied in other allergic conditions and a number of reports have described its efficacy as an immunomodulator in chronic and physical urticaria. Immunopathologic mechanisms are poorly understood. In chronic autoimmune urticaria, it has been postulated that this monoclonal antibody against immunoglobulin (Ig) E might reduce FcepsilonRI expression on the surface of basophils, thus preventing IgG antibody-mediated crosslinking and the release of mast cell mediators. We analyzed activation and homing molecules of B cells and type 1 and type 2 cytokine production by T cells and document a new immunomodulator mechanism characterized by a reduction in B-cell activation and homing and in tumor necrosis factor-alpha and interleukin 4 production and an increase in interferon-gamma synthesis.
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Antialérgicos/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Urticaria/tratamiento farmacológico , Anticuerpos Antiidiotipos , Anticuerpos Monoclonales Humanizados , Linfocitos B/efectos de los fármacos , Linfocitos B/inmunología , Femenino , Humanos , Interferón gamma/sangre , Interleucina-4/sangre , Activación de Linfocitos/efectos de los fármacos , Persona de Mediana Edad , Omalizumab , Factor de Necrosis Tumoral alfa/sangre , Urticaria/inmunologíaRESUMEN
BACKGROUND: Epidemiological studies on the association between allergic disorders, T-helper type 2 (Th2) mediated, and multiple sclerosis (MS), a T-helper type 1 (Th1)/Th17-mediated disease, provided conflicting results. OBJECTIVE: The aim of this study was to further examine the association between allergic disorders and MS. METHODS: The association between MS and previous medical history of any type of allergy has been investigated in a population-based case-control study conducted in Northern Italy, based on telephone interviews to 423 cases and 643 population controls (refusal rates 3.7% and 9.4%, respectively). Controls were a random sample of the general population. RESULTS: A history of atopic allergies seems to confer protection against MS (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.38-0.89; P = 0.012). In particular, the prevalence of allergic asthma was 4.9% in people with MS and 12% in control subjects (OR = 0.38; 95% CI 0.22-0.66, P < 0.01). No association was found between MS and nonatopic allergies. CONCLUSIONS: Our findings are confirmatory of the putative protective effect of Th2-mediated disorders on Th1 immune responses associated with MS. A unifying theory on the mechanisms by which previous history of atopic allergies may modify the risk of MS is still lacking.
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Hipersensibilidad/epidemiología , Esclerosis Múltiple/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Hipersensibilidad/inmunología , Italia/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/inmunología , Esclerosis Múltiple/prevención & control , Oportunidad Relativa , Vigilancia de la Población , Prevalencia , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Células TH1/inmunología , Células Th2/inmunología , Adulto JovenRESUMEN
The monoclonal antibodies against CD8 (T suppressor/cytotoxic) antigen (Leu2/OKT8) were found to bind to leukaemic lymphocytes from a patient with chronic lymphocytic leukaemia. The cells also had an unusual type of rod-like cytoplasmic immunoglobulin of IgM/lambda type as seen by light, fluorescence and electron microscopy, and displayed several antigens characteristic for B lymphocytes. Gene rearrangement analysis showed rearrangement of mu heavy chain gene. In spite of an expression of CD8 antigen, T-cell receptor genes were not rearranged.