RESUMO
BACKGROUND: The immunomodulatory effects of helminths have been well described. However, there is a relative lack of literature regarding the link between parasites and allergic diseases. A number of patients with allergic symptoms have positive serologic test results for Strongyloides stercoralis. OBJECTIVE: To identify patients with allergy-type symptoms and coexisting Strongyloides infection and to analyze the effect of Strongyloides eradication therapy with ivermectin on these symptoms. METHODS: The medical records of our allergy clinic sites were reviewed for Strongyloides test results between January 2011 and October 2014. Each allergy-type symptom was assessed separately with regard to improvement after ivermectin therapy. RESULTS: Among the 1,446 patients who had Strongyloides serologic tests ordered, 127 (8.8%) had positive test results. Eighty-four patients had follow-up data regarding allergy-type symptoms after ivermectin treatment. Among these, 52 patients (61.9%) reported skin-related problems (pruritus, urticaria, angioedema, and/or rash). Forty-nine patients (58.3%) had asthma, and 73.8% had allergic rhinoconjunctivitis. Although respiratory symptoms typically did not respond to ivermectin treatment, 24 of 48 patients (50%) with skin symptoms reported a significant subjective improvement of symptoms after ivermectin treatment. Peripheral eosinophil counts significantly decreased after ivermectin treatment from 450 to 200/µL (P < .001). CONCLUSION: Serologic testing for strongyloides may be indicated for patients with allergy-type symptoms and a suggestive exposure history. Patients with strongyloidiasis and primarily cutaneous symptoms experienced significant symptomatic improvement after ivermectin therapy.
Assuntos
Antiparasitários/uso terapêutico , Hipersensibilidade/tratamento farmacológico , Ivermectina/uso terapêutico , Strongyloides stercoralis , Estrongiloidíase/tratamento farmacológico , Adulto , Idoso , Animais , Eosinófilos/imunologia , Feminino , Humanos , Hipersensibilidade/sangue , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estrongiloidíase/sangueAssuntos
Asma/diagnóstico , Negro ou Afro-Americano , Strongyloides stercoralis/imunologia , Estrongiloidíase/diagnóstico , Alérgenos/imunologia , Animais , Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos/imunologia , Asma/tratamento farmacológico , Doenças Endêmicas , Eosinofilia , Humanos , Imunoglobulina E/sangue , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Carga Parasitária , Estrongiloidíase/tratamento farmacológico , Estados UnidosAssuntos
Alergia e Imunologia , Dessensibilização Imunológica/métodos , Registros Eletrônicos de Saúde , Hipersensibilidade/diagnóstico , Software , Alérgenos/imunologia , Alérgenos/uso terapêutico , Protocolos Clínicos , Tomada de Decisões Assistida por Computador , Humanos , Hipersensibilidade/epidemiologia , Informática Médica , Avaliação de Resultados da Assistência ao Paciente , Satisfação do Paciente , Projetos Piloto , Testes CutâneosAssuntos
Antivirais/efeitos adversos , Hipersensibilidade a Drogas/complicações , Eosinofilia/complicações , Hepatite C/complicações , Estrongiloidíase/complicações , Animais , Antiparasitários/uso terapêutico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/fisiopatologia , Eosinofilia/etiologia , Eosinofilia/fisiopatologia , Hepatite C/etiologia , Hepatite C/fisiopatologia , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/efeitos adversos , Prednisona/uso terapêutico , Proteínas Recombinantes/efeitos adversos , Ribavirina/efeitos adversos , Strongyloides , Estrongiloidíase/etiologia , Estrongiloidíase/fisiopatologia , SíndromeRESUMO
BACKGROUND: To determine whether demographic and behavioral factors affect immunoglobulin regulation in HIV infection, we studied injection drug users, women, and minority ethnic and racial groups with and without HIV infection. MATERIAL/METHODS: A prospective cross-sectional study of ambulatory persons with or at risk for HIV infection was conducted. We enrolled 48 injection drug users (IDUs) and 43 non-IDUs seropositive for HIV and 22 seronegative at-risk individuals in the Bronx, New York City. Sixteen HIV-seronegative, non-IDUs controls were also studied. Total serum immunoglobulin levels, IgG subclasses and lymphocyte phenotypes were measured. RESULTS: Serum IgG, IgA, IgG(1) and IgG(3) were increased in all stages of HIV infection controlling for injection drug use, gender, race and age (p0.05). Serum IgM levels were significantly decreased in HIV seropositives compared to HIV seronegatives (p<0.02). Two patterns of serum immunoglobulin level elevation were found in HIV infection: 1) IgG, IgG(1) and IgG(3) levels were elevated in early and advanced HIV infection; 2) IgA, IgG(2) and IgG(4) levels were elevated only in advanced HIV infection. IgG levels were increased in Blacks compared to Caucasians with HIV infection (p=0.01). CONCLUSIONS: Serum IgG, IgG(1) and IgG(3) levels are increased in early HIV infection, while serum IgA, IgG(2), and IgG(3) levels are increased only in advanced HIV infection. In contrast, serum IgM levels are decreased in HIV infection. HIV-seropositive Blacks have higher serum IgG levels than HIV-seropositive Caucasians. Further studies are necessary to determine the mechanism(s) underlying the different patterns of immunoglobulin elevation in HIV infection.
Assuntos
Comportamento , Etnicidade , Infecções por HIV , Imunoglobulina G/sangue , Imunoglobulinas/sangue , Adulto , Fatores Etários , Feminino , Infecções por HIV/sangue , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/sangue , Abuso de Substâncias por Via Intravenosa/imunologiaRESUMO
Asthma is an environmental disease that is caused in most patients by the continual inhalation of allergens. There are many different types of indoor and outdoor allergens and the exact sensitivities to these vary between people. Thorough and continuous allergen removal is the safest and most cost-effective means of treating asthma and should be undertaken in every patient. Environmental control should be done by every asthmatic regardless of perceived or actual allergic sensitivity, both because allergy testing has a significant false-negative rate because prolonged exposure to allergen will produce new sensitivities.