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Asthma, allergic rhinitis and atopic dermatitis are multifactorial disorders influenced by various familial and environmental factors. Cord blood IgE levels may be predictive for subsequent allergy onset. Serum IgE assessment has been rarely investigated. This study is aimed at evaluating serum IgE levels during the first year of life and relating to subsequent allergies. Total serum IgE levels were assessed in 102 newborns in the first days of life (2–3) and then again at 3, 5, 6, 11 and 12 months of age. After ten years, paediatricians and general practitioners caring for these children were tracked through the Local Healthcare Agency (LHA) database and asked about possible allergy of their patients, including transient ones. F Serum IgE increased in allergic infants at 1 year of life. The predictive model was significant. In conclusion, this study demonstrates that serum IgE may be predictive of subsequent allergy onset, preferably if assessed at 1 year of age.

Little information is available about the long-term outcome of renal transplantation in patients with systemic vasculitis (SV). We compared the outcomes of 19 renal transplant recipients with SV with those of 38 controls matched for time of transplantation, age, gender and source of donor. The mean post-transplant follow-up was 58 ± 57 months for vasculitic patients and 61 ± 49 months for controls. The actuarial 10-year patient survival was 87 in vasculitic patients and 90 in controls, death-censored graft survival were 84 and 100, respectively. The risks of acute and chronic rejection, and arterial hypertension were not significantly different between the two groups. Infection was significantly more frequent in vasculitic patients (74 vs. 34; p 0.01). Seven patients (36.8) had a recurrence of vasculitis in mean 45 months after renal transplant (0.076patientsyear). After recurrence, one patient had an irreversible humoral rejection, another died from hemophagocytosis and another restarted dialysis 1 year later. Long-term patient and renal allograft survival in vasculitic patients was good. Although graft function recovered in most relapsers after reinforcement of immunosuppression, one patient died and two lost graft function.

Carriers of a double thrombophilic mutation (factor V Leiden and prothrombin G20210A) are at high risk of a recurrent venous thromboembolism (VTE), and may benefit from a longer course of secondary prophylaxis. We examined the costs and health benefits of screening for both the mutations, provided that double heterozygotes undergo 2 years of anticoagulation as compared to the standard 6 months. We thus pooled the available evidence and calculated that the OR for recurrence in double heterozygotes was 5.9 (95% CI 2.65–13.20). A Markov model tracked patients’ health lifelong, and calculated that prolonged prophylaxis saved 26 quality‐adjusted days of life and $410 per double heterozygote treated. Screening all the patients with venous thromboembolism thus provided one additional day of life at the cost of 13624 $/QALY (95% CI 12 965–22 889). Screening was not cost‐effective in those cohorts with a low prevalence of the mutations, a high bleeding risk or in those where prophylaxis prevented <65% of recurrences. Screening for factor V Leiden and prothrombin G20210A, with prolonged prophylaxis of double carriers, is cost‐effective in most patients with VTE.

A mathematical model of iron metabolism is presented. It comprises the following iron pools within the body: transferrin-bound iron in the plasma.iron in circulating red cells and their bone marrow precursors, iron in mucosal, parenchimal and reticuloendothelial cells. The control exerted by a hormone, called erythropoietin, on bone marrow utilisation of iron for hemoglobin synthesis is taken into account. The model so obtained consists of a system of differential equations of retarded type. Most model parameters can be estimated from radiotracer experiments, others can be measured and numerical values can be assigned to the remaining ones making few reasonable assumptions consistent with the available physiological knowledge. Iron metabolism behavior under different therapeutical treatments was simulated. Model predictions were compared to experimental data collected in clinical routine.

A methodology for the study of erythroid disorders by means of a mathematical model of iron kinetics and classification techniques are presented. Iron flows along the pathway linking iron pools in the body can be quantitated by estimating model parameters from tracer data. This provides a quantitative assessment of erythropoiesis, since iron is used for hemoglobin synthesis. Multivariate analysis techniques in the space of estimated ferrokinetic parameters enabled us to obtain a new functional classification of erythroid disorders.

Red cell ferritin was measured in normal subjects and patients with disorders of iron metabolism, inflammation, liver dysfunction, impaired hemoglobin synthesis, and increased red cell turnover by means of radioimmunoassays with antibodies to liver (basic) and heart (acidic) ferritins. The normal mean values for basic and acidic ferritin were 8.9 and 22.7 altogram (ag)/cell, respectively. The red cell ferritin content reflected changes occurring in tissues both in iron deficiency and iron overload. Basic ferritin was more closely related to the body iron status than acidic ferritin, and the acidic/basic ferritin ratio was increased in iron deficiency and decreased in iron overload. The major factor determining the red cell ferritin content appeared to be the transferrin saturation, that is, the distribution of iron between monoferric and diferric transferrin. This is in keeping with recent data indicating a competitive advantage of diferric transferrin in delivering iron to erythroid cells. In addition, the red cell ferritin content was increased in thalassemic patients with normal iron status, appearing to be inversely related to the rate of hemoglobin synthesis. The determination of red cell ferritin, based on a commercially available basic ferritin assay, can have clinical application. It can be used for evaluating the adequacy of the iron supply to the erythroid marrow, particularly in patients with increased red cell turnover. Moreover, it may be useful in evaluating the body iron status in patients with hemochromatosis and liver disease.

In this study, we retrospectively analyzed the effects of treatment in 19 patients with membranous lupus nephritis (MLN) and nephrotic syndrome. Eight patients were treated with corticosteroids alone, and the other 11 patients received methylprednisolone and chlorambucil alternated every other month for 6 months. At presentation, sex, age, duration of renal disease before renal biopsy, plasma creatinine, and arterial hypertension were similar in the two study groups. Of the eight patients treated with corticosteroids alone, three showed complete remission and one partial remission of the nephrotic syndrome. During the follow-up (mean, 114+/-63 months), seven of these eight patients developed one or more renal flare-ups. Of the 11 patients treated with methylprednisolone and chlorambucil, seven had complete remission, and the other four had partial remission of the nephrotic syndrome. During the follow-up (mean, 83+/-59 months), only one patient had renal flare-up. At the end of the follow-up, all patients were alive, but three patients in the group treated with corticosteroids alone had developed a doubling of plasma creatinine, and another patient had persistent nephrotic syndrome. Two other patients were in complete remission, one patient was in partial remission, and the last patient had nonnephrotic proteinuria. In the group of patients treated with methylprednisolone and chlorambucil, one patient developed extracapillary glomerulonephritis and eventually entered end-stage renal failure 24 years after the clinical onset of renal disease. Seven patients were in complete remission, and three patients were in partial remission at the last follow-up visit. This retrospective study suggests that methylprednisolone and chlorambucil may induce a more stable remission of nephrotic syndrome and may better protect renal function in the long term in comparison with corticosteroids alone. However, these results must be confirmed by a prospective controlled trial. (Am J Kidney Dis 1998 Apr;31(4):681-6)

IgE cross-reactivity between pollen and food allergens represents the molecular basis for oral allergy syndrome (OAS).

BACKGROUND: MMM is a rare chronic myeloproliferative disease with heterogeneous clinical presentation, natural history and prognosis. Knowledge about MMM is burdened by limited sample size and selection bias of the available studies. AIM: To get a clinical classification of MMM for biological and clinical studies. METHODS: The database of the RIMM, a population-based prospective cohort started in 1999, was enquired and data of 861 patients at diagnosis were extracted. The EM-algorithm (WEKA software) was used for a non-supervised data-mining based on 11 variables: age, spleen size, constitutional symptoms, hemoglobin level, platelet and blood cell count, LDH and percentages of erythroblasts, immature myeloid cells, blasts, and basophils. Differences among clusters were first tested with ANOVA or n-way Chi-square and subsequently investigated with t-test or 2x2 Chi-square. Survival differences among clusters were tested through Cox univariate and multivariate regression analysis. RESULTS: Five clusters (C) were identified: C1 identified younger patients with thrombocytosis and scarce myeloproliferation. C2 also identified patients with a high platelet count, but older and anemic. C3 identified patients with intense myeloproliferation (marked leukocytosis and splenomegaly), while C4 (5% of the patients) collected patients with an even more severe myeloproliferation, associated with a high number of circulating immature myeloid cells and blasts. C4 was also characterized by frequent chromosome abnormalities, anemia and thrombocythopenia. Finally, C5 identified patients with bilinear/trilinear cytopenias. The clusters also differed for variables not incorporated by the data-mining process, i.e. CD34+ cell count (p=0.028); i.e. the rate of homozygous V617F mutation of JAK2 gene, which was significantly higher in C3 and C4 (32.4% vs 12.5%, p=0.019). The clusters also significantly differed for overall survival (p<0.0001), independently of patients’ age. Finally, referral patterns differed among clusters, with C5 and C1 patients being mostly referred to Internal Medicine and Hematology units (p<0.01), respectively. CONCLUSIONS: Thanks to a large and unbiased repository of cases, we identified 5 classes of MMM patients with specific clinical presentation. The biologic and prognostic value of the clusters deserves further investigations at longer follow-up periods. Clinical parameters in the different clusters (means) CLUSTER AGE (yrs) * HB (g/l) */PLT*10(9)* WBC *10(9) * SPLEEN (cm) * BLASTS*(%) CD34 %/μl SEVERITY SCORE§ * * p<0.0001 § The score considers HB, WBC, PLT and SPLEEN (Barosi, Leuk Lymph 2002). 1 56.7 13.3 /583 11.5 3.5 0.21 0.85 /63 1.25 2 72.1 10.6 /482 18.3 2.7 0.82 1.12 /297 2.04 3 65.1 10.8 /303 18.3 9.9 1.47 1.7 /313 2.54 4 67.6 8.4 /110 27.5 13.4 5.66 2.72 /275 4.30 5 68.2 8.4 /134 4.2 6.8 0.78 2.92 /52 3.36 All 65.5 10.7 /362 13.5 6.5 1.18 1.78 /200 2.36