Clinical Immunology: Case Study - Essay Example

Clinical Immunology: Case Study 1. After the patient, Christopher was given a series of allergen skin prick tests he was shown to be diagnostically sensitive to milk, egg white, cod, peanuts, tree nuts, mold spore, dust mites, and animal dander. 2. Christopher has a positive allergen specific IgE to house- dust mites as demonstrated symptomatically with atophy and rhinitis. A portion of the population may show negative responses in SPT’s and are unresponsive to any of the compounds though it is possible for an auto immune response to be presented as shown through the presence of allergen- specific IgE in the serum (Pierson-Mullan, Jackola, Blumenthal, & Rosenberg,2002:110). Those who test positively in the SPT will have higher concentrations of specific IgE’s than those who are negative. 3. With milk being one of the first allergens often introduced to the system a study completed by the Institute of Medical and Chemical Laboratory Diagnostic determined a major allergen of milk is alphas1-casein. This can be shown through the expression of the allergen as escherichia coli (Schulmeister,et al, 2009). There are numerous proteins in milk which have been shown to be allergens with most of these containing several epitopes which are allergenic (Crittenden, and Bennett, 2009). This is further complicated because the reactions derived from cow’s milk are a combination of immunological reactions. With egg allergens primarily affecting the skin they most commonly cause eczema as a symptom of the allergy. Egg proteins which have been identified as allergens are located primarily in egg whites ( Hildebrandt,Steinhart, Paschke. 2008:1088). These proteins are conalbumin, ovalbumin, ovomucoid and lysozyme. Though these proteins make up close to 80% of the proteins the specific allergenicity of each protein is not known. Lysozyme has been shown in some studies to be the weakest of the allergens (Hoffman, 1983). The major allergens of peanuts have been recognized as seed storage protein and an allergic response to other tree nuts is likely because they contain very similar protein allergens (Barre, et al, 2008:1231). Because there is still some controversy over the relationship of peanuts and tree nuts it is still crucial to avoid both. To determine the similarities the seed storage protein surfaces must be further studied for similarities. 4. While TH1 and TH2 develop and evolve from the same precursor cell it is activated TH2 cells which produce IL-4, IL-13, and IL-5 cytokines. It is the failure of TH1 allergen specific response to convert to a TH1 response which is associated with an increased allergy response due to less microbial exposure early in life (Sudha, et al, 2010: 66).The cytokine IL-4 initiates a switch to producing IgE due to differentiating B cells. Sudha noted there was a strong correlation of IL-4 and IL-5 in most cases of allergic rhinitis, uriticaria and allergic asthma in patients. IL-13 was noted only in those patients with uriticaria or skin issues. IL-13 is similar to IL-4 while regulating to some degree IgE though unlike IL-4 it plays no part in regulating T cell differentiation and has no effect on T cells. IL-4 is a major target for therapeutic agents in treating atopic disease. There increase is an assurance of higher IgE production which lead to allergic reaction. IL-4 and IL-13 are known cytokines which are involved in the pathology of allergies and allergic asthma. TH17 cells are different from TH1 and TH2 cells. TH17 cells are proposed to play an important role in various disorders previously considered to be TH2 disorders such as allergic conditions (Yang, 2012: 236). Though TH17 cells have only recently began to be scrutinized and studied they are thought to induce and organize the inflammation of tissue (Sallusto and Lanzavecchia, 2009:622). TH17 cells produce IL-17 while IL-17 along with IL-22 create a large tissue reaction as these cells are broadly distributed. TH-17 also is responsible for excreting IL-21 which coordinates with the immune system and helps to clear pathogens in defense mode while actually causing an inflammatory response in allergic diseases. 5. Release assays used in allergy patients’ give various information about allergen-induced Basophil histamine, Mast cell ,PGD2 and Eosinophil Cationic Protein (ECP). Mast cells and basophil each make and release histamines. That which is most often measured is histamine though IL-4 and IL-13 can also be measured. Assays are done with blood analysis and are able to detect many allergies including latex, pollen, foods, and venom. Basophils and mast cells are both releasers of histamines and these assays can detect auto antibodies which are functioning as they should (Kamran,Bhargava1,Skov2,Falkencrone and Grattan, 2012). With the preceding years seeing the development of cloning of allergens and provided in recombinant form new diagnostic tests have been created. Current studies have been focusing on allergen-induced activation of IgE bearing cells such as basophils which have numerous binding sites (Valent, et al, 2004). Histamine release is given as a percentage of histamine and for diagnostic purpose the value should be >10% (or>5% after subtraction of spontaneous release) if the result is positive or dose dependent (Valent, et al, 2004). The ECP involves the very important eosinophil cells which are involved in the mediation of the inflammatory process. It is suspected that more activated eosinophils circulating in the blood stream indicate active conditions which are considered inflammatory. The assay of ecp’s is very helpful in monitoring inflammatory conditions. The severity of skin conditions, asthma, and monitoring the effects of therapy have been greater with assays over more subjective measures. 6. The ‘hygiene hypothesis’ essentially states that due to a lack of exposure to certain agents in early childhood resistance was not established by the body against autoimmune and allergic diseases (Okada, Kuhn, Feillet, and Bach, 2010). The proportion of children suffering from allergic diseases in industrialized countries has risen steadily in the last ten years. When actions were taken to limit public health threats and reduce infections in many countries and these countries have done very good at reducing diseases such as hepatitis A. In a weird twist of events countries who have very poor health standards have much lower incidences of allergic diseases. Some countries who have eradicated diseases such as soil-transmitted helminthiasis are now seeing an increase in allergic diseases. Migration patterns are somewhat responsible for this as those have never been exposed to certain factors are now being exposed and immune systems are attempting to keep up. It is thought that during childhood we build up immune defenses as our body acquires and learns how to rid threats and foreign invaders. Large migration patterns expose populations to conditions and bacteria or virus’ to which they have never built immunity to. An example of this may be the chicken pox virus; while most acquired this during childhood and are now immune those who did not are a much older population now less able to defend against the chicken pox. For this reason vaccinations are given which expose you to the virus’ and allow your body to build natural immunity to the virus as if you’d had the virus as a child. The response of TH1 and TH2 cells were first indicated in the explanation for the influence some disease agents have in protecting us. It is suggested that lack of microbial burden in early childhood, primarily in developed countries where TH1 immunity is stronger shifts the direction towards TH2 cell mediation leading to more allergic diseases (Okada, Kuhn, Feillet, and Bach, 2010). 7. Topical steroids worked in Christopher’s atopic dermatitis because they decrease inflammation and have immunosuppressive, and vasoconstrictive effects which reduce itching and irritation (Gelbard, & Hebert,2008). They are now created in vehicles which ensure they are effective. 8. Immunological responses associated with Omalizumab treatment are that CD4 T cell responses are eradicated or greatly reduced to the allergen (Bedoret, et al ,2012). Omalizumab may also reduce FcepsilonRI expression in basophils whose surfaces are prevented from crosslinking and the release of mast cell mediators. There is a reduced amount of B cell activation and an increase in interferon-gamma synthesis (Iemoli, et al, 2010). 9. Christopher is not a good candidate for immunotherapy as the research at this point is still very limited. There are no available therapy’s for food allergies and as Christopher has more than two allergies it is unlikely he would be treated in this way. Eczema is not able to be treated in this manner neither. Changes you would expect to see using this therapy would be few TH2 activated cells producing IL-4, IL-13, and IL-5 cytokines which are attributed to many inflammatory responses and a lower concentration IgE. 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(2012) Allergen induced Th17 response in the peripheral blood mononuclear cells (PBMCs) of patients with nasal polyposis, International Immunopharmacology, 12,1, pp 235-240, ISSN 1567-5769, 10.1016/j.intimp.2011.11.016. Read More