Effect of Cluster Allergen-Specific Immunotherapy in Patients with Atopic Dermatitis Sensitive to House Dust Mite.

Atopic dermatitis (AD) is a chronic IgE-mediated skin disorder. Clinical usefulness of allergen-specific immunotherapy in the treatment of AD is still controversial. We assessed the effect of cluster allergen-specific subcutaneous immunotherapy (SCIT) in patients with AD sensitive to house dust mite. The study included 43 patients (32 with mild to moderate AD and 11 with severe AD). Disease severity was assessed by SCORAD index. Patients were treated by cluster SCIT for 8 weeks. SCORAD index, total IgE serum level and blood eosinophilic count (BEC) were assessed at the baseline visit and after the end of immunotherapy. Thirty-one patients (72.1%) responded to SCIT. Responders showed significant decrease in SCORAD index (P < 0.001) and BEC (P < 0.05) compared to non-responders. SCORAD index, total IgE and BEC were significantly decreased in responded patients after SCIT compared to the baseline. The reduction in SCORAD index was 49%. Patients with mild to moderate AD showed no difference in the serum IgE level after SCIT compared to the baseline, but a significant difference was reported in the SCORAD index and BEC. Patients with severe AD showed significant difference in SCORAD index, total IgE, and BEC between baseline and post-SCIT values. Patients with mild to moderate AD showed more reduction in SCORAD index than patients with severe AD (53.8% vs. 43.6%). No adverse reactions were reported during immunotherapy. We concluded that cluster allergen-specific immunotherapy is an effective and well-tolerated therapeutic modality for both mild to moderate and severe AD.

A search for new otomycotic species and their sensitivity to different antifungals.

BACKGROUND: Otomycosis is a common ear problem in countries with hot and humid climate. Emergence of new fungal species is a possibility particularly in patients with chronic illness or who receives antibiotics either systemically or topically. AIM: To identify the otomycotic species, which are responsible for developing the otomycosis. METHODS: A descriptive study was carried out in 63 patients who were clinically diagnosed with otomycosis. Swabs were taken from the fungal debris to identify the causative agent and to determine the effective antifungals against it. RESULTS: Aspergillus species were the most common agents and were found in 47 patients (74.6%), represented by A. fumigatus (36.5%), A. niger (27%), A. flavus (6.5%), and A. terreus (4.8%). Ketoconazole (90%) and miconazole (76%) were the most effective antifungals against the species obtained from cultures, whereas fluconazole was the least effective. CONCLUSIONS: Although there is no change in the mycology of otomycosis, there is still a significant variability in the isolated species and in their sensitivity to antifungal drugs. Ketoconazole exhibited broad spectrum effect against fungal isolates in this study, whereas fluconazole was the least efficacious.

Effect of Allergen Specific Immunotherapy on Serum levels of IL-17 and IL-35 in Allergic Rhinitis Patients.

Allergic rhinitis (AR) is mediated by many proinflammatory and anti-inflammatory cytokines as interleuhin-17 (IL-17) and interleukin-35 (IL-35) respectively. We assessed the effect of allergen specific immunotherapy (IT) on the serum levels of IL-17 and IL-35 in patients with AR sensitive to house dust mites (HDMs). Twenty patients with AR sensitive to HDMs and ten healthy control subjects were included in the study. Sensitivity to HDMs was diagnosed by positive skin prick test. Patients were treated by cluster IT. They were assessed by medical history, skin prick test, nasal symptoms scores, and measurement of serum IL-17 and IL-35 levels by ELISA technique before and after IT. All patients showed significant improvement in the skin test reactions and nasal symptoms scores after IT except for the postnasal drip which showed non-significant improvement. Serum IL-17 levels were higher in patients before IT than in control subjects and showed a significant decrease after IT. Serum IL-35 levels were lower in patients before IT than in control subjects and showed a significant increase after IT. No significant difference in the serum levels of IL-17 and IL-35 was observed between the patients and control subjects after IT. It was concluded that allergen specific IT decreases IL-17 and increases IL-35 in patients with AR sensitive to HDMs.

The Effect of Autologous Serum Therapy in Chronic Spontaneous Urticaria Depends on Autologous Serum Skin Test Positivity.

Chronic spontaneous urticaria (CSU) is a common distressing disease caused mainly by autoreactive mechanisms. Autologous serum therapy (AST) has been tried for treatment of many autoimmune diseases including chronic urticaria. We assessed the effect of AST in autologous serum skin test (ASST)-positive and ASST-negative CSU patients. The study included 40 patients clinically diagnosed as CSU. Twenty ASST-positive patients and 20 ASST-negative patients received AST for 8 weeks. Urticarial activity was assessed at baseline, 4th week, 9th week, and at the 12th week by the weekly urticarial activity score (UAS-7) according to the EAACI/GA2LEN/EDF/WAO guidelines. Antihistamine pill burden was assessed at every visit. The mean UAS-7 was significantly decreased in ASST-positive patients after AST at the 4th and 9th weeks (P < 0.05) but the decrease was non-significant at the 12th week. In ASST-negative patients, the decrease in the mean UAS-7 was significant only at the 4th week. Ten percent of the ASST-positive patients showed complete remission after AST and no patients in either group showed relapse after treatment. There was no difference in the mean UAS-7 between the two groups at baseline but significant difference was observed at 4th, 9th and 12th week. The difference in antihistamine pill burden was also significant at the 12th week (P < 0.001). We concluded that AST is more efficient in decreasing disease severity and antihistamine use in ASST-positive CSU patients than in ASST-negative patients.