Immunoglobulin E in irritable bowel syndrome: another target for treatment? A case report and literature review.

Irritable bowel syndrome (IBS) is notoriously difficult to treat and this situation is unlikely to change until the pathophysiology is better understood. There is no doubt that IBS is a multifactorial condition but it is likely that the relative contribution of the various factors involved varies from patient to patient. Consequently, in some individuals one mechanism may have such a strong effect that its elimination may lead to a substantial improvement in symptoms. This paper describes a patient with severe asthma and IBS where the administration of an anti-Immunoglobulin E (IgE) monoclonal antibody not only improved her asthma but also resulted in an almost complete resolution of her IBS symptoms. This observation suggests that some form of allergic process, which may be mediated by IgE, might be driving IBS in some patients and there is evidence from the literature that atopy is more common in this condition. Therefore, in patients with IBS and atopy where the response to standard treatment is poor, it may be worth considering targeting the allergic diathesis. Possible approaches include skin testing with food antigens followed by an appropriate exclusion diet or pharmacological mast cell stabilization

Avaliação da estomatite protética em portadores de próteses totais Evaluation of denture stomatitis in users of complete dentures

As próteses muco-suportadas são consideradas facilitadoras em potencial da estomatite protética (EP), lesão comumente observada sob a base das próteses, caracterizada por aspectos eritematosos difusos ou pontilhados na mucosa de suporte. Sua etiologia é controversa, podendo estar relacionada principalmente a fatores locais. Diversos aspectos funcionais associam-se a estes fatores representados pela oclusão, dimensão vertical, retenção, estabilidade dinâmica e estática além de aspectos qualitativos relacionados às condições encontradas no desdentado. Foram levados em consideração o período de edentulismo, número e tempo de uso das próteses, uso contínuo, conservação, presença de placa e higiene bucal. Os fatores foram avaliados, visando esclarecer a possível relação dos aspectos funcionais e protéticos com a EP. Exame clínico foi realizado em 116 pacientes de ambos os sexos, desdentados bimaxilares, que utilizavam as duas próteses muco-suportadas, portadores ou não de estomatite protética (EP). Os resultados indicaram que a maioria dos pacientes examinados tinha EP frente ao menor número de pacientes sem EP, havendo nos dois grupos equivalência nos resultados da avaliação clínica e protética. Os fatores funcionais e qualitativos das próteses, avaliados isoladamente, não puderam ser considerados responsáveis pela ocorrência dessa patologia, constatando-se que um único fator protético não demonstrou, de per si, ser responsável pela presença da EP, embora possa ser um facilitador para o seu desenvolvimento.<br>Functional and qualitative factors in complete dentures can contribute to the development of lesions in the oral mucosa. Such lesions are classified as denture stomatitis (DS). There are considerable differences of opinion as to its etiology, mainly related to systemic and local factors. The influence of functional and qualitative features of complete dentures on denture stomatitis was evaluated. The functional factors considered were: occlusion, vertical dimension of occlusion (VDO), dynamic and static retention, as well as stability. The qualitative factors were: oral and prosthetic hygiene, continuous use, complete denture status, time of use and time of edentulism. The study group comprised 116 totally edentulous patients, with and without DS, of both genders using tissue-supported prostheses. The data were analyzed through the Chi-square test, at the 0.05 significance level, and through the Fisher test, when the frequency was low. The results indicated that the majority of our patients presented DS. None of these factors was by itself responsible for the presence of DS, indicating that DS was probably due to many factors

Active colitis exacerbates immune response to internalized food antigens in mice

Background: Previous studies have indicated that colitis increases intestinal permeability to food antigens. This condition also generates an immunoreactive milieu in the gut, which may exacerbate or counteract allergy reactions. This, along with the fact that both colitis and allergy are being codiagnosed more frequently, means the scientific interest on the immune relation between these pathologies is increasing. We evaluated the immune response to an internalized food antigen that was initiated during a concomitant active intestinal inflammatory response. Methods: An ovalbumin (OVA)-induced immune response was analyzed in healthy mice and in mice suffering from colitis induced by the administration of dinitrofluorobenzene/dinitrosulfonic acid (DNFB/DNS) at the moment of OVA challenge. The OVA-induced clinical score and allergy response both in plasma and in splenocyte cultures from these animals were compared. Results: Although no differences were observed in the allergy clinical score, the concomitant active colitis led to an increase in the immune response to OVA antigen, as shown by increased spleen size and OVA-induced splenocyte proliferation, exacerbated expression of total and OVA-specific IgG1 levels, increased colonic IL-4 expression and OVA-induced IL-4 and IL-5 cytokine expression in spleen cells. Conclusions: Our results indicate that animals with active colitis undergo an exacerbated immune response to an internalized antigen. This finding could be relevant for the allergy management of patients presenting simultaneously with chronic colitis