IgE-mediated hypersensitivity after ibuprofen administration

Although many immunoglobulin-related drug sensitivities have been described, there is a paucity of reports regarding IgE-related drug sensitivities. Here we describe a case of a patient who demonstrated IgE-mediated sensitivity to ibuprofen

Diclofenac Hypersensitivity: Antibody Responses to the Parent Drug and Relevant Metabolites

Background: Hypersensitivity reactions against nonsteroidal antiinflammatory drugs (NSAIDs) like diclofenac (DF) can manifest as Type I-like allergic reactions including systemic anaphylaxis. However, except for isolated case studies experimental evidence for an IgE-mediated pathomechanism of DF hypersensitivity is lacking. In this study we aimed to investigate the possible involvement of drug-and/or metabolite-specific antibodies in selective DF hypersensitivity. Methodology/Principal Findings: DF, an organochemically synthesized linkage variant, and five major Phase I metabolites were covalently coupled to carrier proteins. Drug conjugates were analyzed for coupling degree and capacity to crosslink receptor-bound IgE antibodies from drug-sensitized mice. With these conjugates, the presence of hapten-specific IgE antibodies was investigated in patients' samples by ELISA, mediator release assay, and basophil activation test. Production of sulfidoleukotrienes by drug conjugates was determined in PBMCs from DF-hypersensitive patients. All conjugates were shown to carry more than two haptens per carrier molecule. Immunization of mice with drug conjugates induced drug-specific IgE antibodies capable of triggering mediator release. Therefore, the conjugates are suitable tools for detection of drug-specific antibodies and for determination of their anaphylactic activity. Fifty-nine patients were enrolled and categorized as hypersensitive either selectively to DF or to multiple NSAIDs. In none of the patients' samples evidence for drug/metabolite-specific IgE in serum or bound to allergic effector cells was found. In contrast, a small group of patients (8/59, 14%) displayed drug/metabolite-specific IgG. Conclusions/Significance: We found no evidence for an IgE-mediated effector mechanism based on haptenation of protein carriers in DF-hypersensitive patients. Furthermore, a potential involvement of the most relevant metabolites in DF hypersensitivity reactions could be excluded

Martial arts intervention decreases pain scores in children with malignancy

Martin H Bluth,1,2 Ronald Thomas,3,4 Cindy Cohen,2 Amanda C Bluth,5 Elimelech Goldberg,2,4 1Department of Pathology, Wayne State University School of Medicine, Detroit, MI, 2Kids Kicking Cancer, Southfield, MI, 3Children’s Research Center of Michigan at Children’s Hospital of Michigan, Detroit MI, 4Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, 5Wayne State University, Detroit, MI, USA Background: Martial arts intervention in disease has been mostly limited to adult inflammatory, musculoskeletal, or motor diseases, where a mechanical intervention effects positive change. However, the application and benefit to pain management in childhood malignancy are not well described. Here, we assess the effects of defined martial arts intervention in children with cancer with respect to their pain perception and management. Methods: Sixty-four children with childhood malignancies were enrolled in a martial arts program, which encompassed both meditation and movement modalities. Pain scores (0–10) were recorded pre- and post- 1-hour session intervention. Pain scores were crossed by total visits and tabulated by whether participant pain reduced at least 1 unit, stayed the same, or increased in intensity immediately after (post) participation session. Differences in pain scores were further compared by age and sex. Results: Prepain and postpain scale data were measured for 64 participants, 43 males (67.2%) and 21 females (32.8%), ranging from 3 years to 19 years. Preintervention and postintervention data were obtained for 223 individual session visits. Mean number of patient participation visits was 1.8±1.6 (range one to nine visits). Of 116 individual measured sessions where the participants began with a pain score of at least 1, pain intensity reduced ≥1 unit in 85.3% (99/116) of visits, remained the same in 7.8% (9/116), and increased in 6.9% (8/116). For the majority (96.3%; 77/80) of sessions, participants began with a prepain intensity score of at least 5–10 with reduction in pain intensity following the session. The overall mean pain score presession visit was reduced by ~40% (pre: 5.95±2.64 and post: 3.03±2.45 [95% CI: 2.34–3.50]; P≤0.001). Median pain intensity scores had greater reductions with increased age of participants (3–6 years [-1], 7–10 years [-2], 11–14 years [-3], and 15–19 years [-4]). Conclusion: Martial arts intervention can provide a useful modality to decrease pain in childhood cancer, with greater effect achieved with higher baseline pain scores and patient age. Martial arts intervention may improve patient compliance with respect to medical and surgical management, thus reducing disease morbidity and health care costs. Keywords: martial arts, karate, cancer, pain, intervention, therap

Corynebacterium urealyticum: a comprehensive review of an understated organism

Nagla Salem,1 Lamyaa Salem,2 Sally Saber,2 Ghada Ismail,2 Martin H Bluth1 1Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA; 2Department of Clinical and Chemical Pathology, Ain Shams University, Cairo, Egypt Abstract: Corynebacterium urealyticum is a Gram positive, slow-growing, lipophilic, multi-drug resistant, urease positive micro-organism with diphtheroid morphology. It has been reported as an opportunistic nosocomial pathogen and as the cause of a variety of diseases including but not limited to cystitis, pyelonephritis, and bacteremia among others. This review serves to describe C. urealyticum with respect to its history, identification, laboratory investigation, relationship to disease and treatment in order to allow increased familiarity with this organism in clinical disease. Keywords: Corynebacterium urealyticum, cystitis, pyelonephritis, bacteremia, micro-organism

Long-term persistence of IgE anti-influenza A HIN1 virus antibodies in serum of children and adults following influenza A vaccination with subsequent H1N1 infection: a case study

Tamar A Smith-Norowitz,1 Melanie Kusonruksa,2 Darrin Wong,2 Moshe M Norowitz,2 Rauno Joks,3 Helen G Durkin,2 Martin H Bluth41Department of Pediatrics, 2Department of Pathology, 3Department of Medicine, Center for Allergy and Asthma Research, SUNY Downstate Medical Center, Brooklyn, New York, NY; 4Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USABackground and methods: The role of immunoglobulin (Ig) E in immunity against influenza A H1N1 has not been studied. Total serum IgE and specific IgE and IgG anti-H1N1 virus responses were studied in children and adults (n = 2) who received influenza virus vaccination (Flumist® or Fluzone® ) in autumn 2008 and 2009, and then subsequently became infected with the H1N1 virus in spring 2009. Twelve months after infection, antibodies in their serum were compared with those in the serum of subjects who were either vaccinated but not infected (n = 4) or nonvaccinated and noninfected subjects (n = 2), using UniCAP total IgE fluoroenzyme immunoassay, sodium dodecyl sulfate polyacrylamide gel electrophoresis, and Western blotting. Band sizes for the influenza virus (58, 56, 40, 30, 25, and 17 kDa) and H1N1 viral proteins (58, 56, 25, and 17 kDa) were determined, using sodium dodecyl sulfate polyacrylamide gel electrophoresis and Coomassie brilliant blue.Results: We found that the serum of vaccinated and subsequently infected children and adults contained IgE and IgG antibodies to both H1N1 and influenza virus, with a strong IgE and IgG band intensity at 56 kDa. Interestingly, in subjects who were vaccinated but not infected, band intensity at 56 kDa was lowered by approximately two-fold. Serum of nonvaccinated and noninfected subjects had no detectable IgE or IgG antibodies to influenza virus or H1N1.Conclusion: This is the first description of IgE anti-influenza A H1N1 antibodies in human serum and the first demonstration of their long-term persistence. The decreased intensity of the 56 kDa band in vaccinated noninfected subjects compared with vaccinated infected subjects suggests augmented IgE and IgG antibody responses to influenza A H1N1.Keywords: influenza A H1N1, immunoglobulin E, vaccinatio

Stratospheric circulation in seasonal forecasting models: implications for seasonal prediction

Accurate seasonal forecasts rely on the presence of low frequency, predictable signals in the climate system which have a sufficiently well understood and significant impact on the atmospheric circulation. In the Northern European region, signals associated with seasonal scale variability such as ENSO, North Atlantic SST anomalies and the North Atlantic Oscillation have not yet proven sufficient to enable satisfactorily skilful dynamical seasonal forecasts. The winter-time circulations of the stratosphere and troposphere are highly coupled. It is therefore possible that additional seasonal forecasting skill may be gained by including a realistic stratosphere in models. In this study we assess the ability of five seasonal forecasting models to simulate the Northern Hemisphere extra-tropical winter-time stratospheric circulation. Our results show that all of the models have a polar night jet which is too weak and displaced southward compared to re-analysis data. It is shown that the models underestimate the number, magnitude and duration of periods of anomalous stratospheric circulation. Despite the poor representation of the general circulation of the stratosphere, the results indicate that there may be a detectable tropospheric response following anomalous circulation events in the stratosphere. However, the models fail to exhibit any predictability in their forecasts. These results highlight some of the deficiencies of current seasonal forecasting models with a poorly resolved stratosphere. The combination of these results with other recent studies which show a tropospheric response to stratospheric variability, demonstrates a real prospect for improving the skill of seasonal forecasts