Allergy proceedings : the official journal of regional and state allergy societies最新文献

Studies on the immediate and long-term effects of radiation on the B-system immunity of children who were affected by radiation after the Chernobyl disaster (from 1986-1992) are summarized in this paper. Complete clinical and immunological examination of more than 6000 children have been carried out. The dynamics of the immune system, with ongoing reactions of cell proliferation and differentiation, gene amplification, transcription, translation, biosynthesis and switching production of isotypes and subclasses of immunoglobulins, as well as specific and nonspecific (natural) antibodies, make it highly susceptible to the action of radiation in addition to other ecological factors. B-system of immunity (B-cel level, concentration of immunoglobulins-M, G, A, E; subclasses of IgG (IgG1-IgG4) in the serum and saliva, and the level of nonspecific heterophilic autoantibodies (RF, antithyroglobulin) were investigated in children of differing ages and sex living in the territories of the Republic of Belarus contaminated with radionuclides. Research showed decreased levels of B-cell and IgM and IgG isotopes 40-50 days after the disaster and increased levels of IgA immunoglobulins at that time. Long-term effects of low doses of radiation showed increased concentrations of IgM and IgG, correlating changes in the B-system of immunity with the level of 137Cs contamination in the territory of residence and also with the amount of 137Cs found in the children.

Stevens-Johnson Syndrome (SJS) may have considerable morbidity and mortality. Traditional management has been supportive with or without corticosteroids, and we have previously reported our successful experience treating 41 SJS patients with corticosteroids. We now report the outcome of prospectively treating 13 additional patients with SJS with high doses of corticosteroids. Thirteen consecutive patients with SJS were treated with corticosteroids at diagnosis. Their clinical course and outcomes were analyzed. Drug reactions were potential precipitants of SJS in 12 patients. The percent of skin involvement ranged from 30% to 90% with eight patients having greater than 80% involvement. Bullous lesions were seen in two patients. All patients made a complete recovery. Corticosteroid therapy may be lifesaving in these patients; and in our experience, early management of SJS with high dose corticosteroids has been very effective and associated with a full recovery.

The pathogenesis of HIV has been evaluated by many investigators, yet the precise reasons for certain patients developing lethal infection while others appear to live for long periods tolerating the HIV virus remain to be determined. The immune response to HIV may be critical in the development of the fatal infected stated, while tolerance of the HIV virus may allow longer-term survival despite infection. The mechanisms for failure of immune protection from HIV and the subsequent development of immunodeficiency are likely related to the very nature of the immune response to the initial HIV infection.

Erythema Multiforme is an acute, self-limited inflammatory cutaneous disorder characterized by distinctive target lesions. Stevens-Johnson syndrome (SJS) is defined as severe erythema multiforme with mucosal involvement, visceral involvement, or both. Both diseases are part of a continuum of immunologically mediated mucocutaneous diseases at various grades of severity. Viral infections are known triggers of these skin disorders. We report the success of a management strategy of acyclovir and prednisone for herpes simplex virus-associated erythema multiforme. In addition we describe the apparent first case of primary varicella infection as a direct cause of SJS. The two cases are presented and a single-case statistical analysis has been employed to evaluate the significance of the management protocol. The method of analysis is presented in the appendix. When a patient with primary varicella infection develops bullous lesions, SJS should be considered in the differential diagnosis, as early and intense corticosteroid therapy may be lifesaving. A regimen of prophylactic acyclovir and therapy for an exacerbation of herpetic lesions with acyclovir and prednisone was effective in inducing significant control of recurrent erythema multiforme secondary to herpes simplex in our patient.

This symposium describes the advances in immunology that have occurred in the Commonwealth of Independent States. The worldwide difficulties of allergists and immunologists who face problems including increasing morbidity and mortality from HIV, immunoregulatory disorders, and asthma are also germane to our colleagues in Russia, Belarus, and Ukraine. The unique experiences of Dr. Petrov, who has investigated novel immunomodulators; Dr. Titov, who has studied synthetic immunogens; Dr. Babakhin, who has investigated the effects of modified allergens; and Dr. Sidorovitch, who has explored the pathogenesis and natural history of HIV infections occurring in Russia, offer interesting insights into the advances in immunology that have occurred in the Commonwealth of Independent States. Coping with the tragedies of radiation from Chernobyl and environmental pollution in Ukraine, Drs. Titov and Markov have investigated the effects of these unfortunate disruptions of the environment upon the occurrence of immunoregulatory disorders and asthma, respectively. Under the direction of Drs. Petrov and Khaitov, immunologist from the Commonwealth of Independent States, have conducted studies that are among the leading epidemiological immune investigations of our time to determine the effects of the Chernobyl radiation on the immune system.

Coronal CT is the definitive procedure for radiologic evaluation of sinonasal inflammatory disease, yet many clinicians rely on the less expensive plain film sinus series. We designed a limited four slice coronal CT and prospectively compared it with conventional coronal CT and plain film sinus series in 25 patients to determine whether a limited CT examination is a suitable alternative to these other radiologic procedures in screening for sinonasal inflammatory disease. The presence, amount, and location of mucous membrane disease, opacification, air fluid levels, retention cysts, erosions, and anomalies were recorded for each technique. The limited CT agreed with the complete CT in 82% of the 200 sinus compartments reviewed. Localized disease, usually mucosal thickening of 3 mm or less and missed on the limited CT, but detected on the complete CT, accounted for 22 of 36 errors of interpretation. Underestimation of mucosal disease, usually 2 mm or less, accounted for eight errors and misinterpretation of partial volume effect for three errors. Using complete CT a s the established standard, plain film missed 37 instances of disease detected on the limited CT; 73% involved an error of mucosal thickening 4 mm or greater. A limited coronal CT of the paranasal sinuses offers a potentially lower cost alternative to complete CT in screening for sinonasal inflammatory disease. It is more accurate than plain film series. Localized disease and osteomeatal disease is underestimated with the current protocol, and so a limited CT should not be used for evaluating potential cancer patients or for surgical planning.