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Infection with the enteric protozoan Entamoeba histolytica is still a serious public health problem, especially in developing countries. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of the amoebiasis, and it can lead to serious and potentially life-threatening complications in some people. ALA can be cured by metronidazole (MTZ), however, because it has poor activity against luminal trophozoites, 40&ndash, 60% of treated patients get repeated episodes of invasive disease and require repeated treatments that can induce resistance to MTZ, this may emerge as an important public health problem. Anti-virulence strategies that impair the virulence of pathogens are one of the novel approaches to solving the problem. In this study, we found that low doses of curcumin (10 and 50 &mu, M) attenuate the virulence of E. histolytica without affecting trophozoites growth or triggering liver injury. Curcumin (CUR) decreases the expression of genes associated with E. histolytica virulence (gal/galnac lectin, ehcp1, ehcp5, and amoebapore), and is correlated with significantly lower amoebic invasion. In addition, oxidative stress is critically involved in the etiopathology of amoebic liver abscess, our results show no changes in mRNA expression levels of superoxide dismutase (SOD) and catalase (CAT) after E. histolytica infection, with or without CUR. This study provides clear evidence that curcumin could be an anti-virulence agent against E. histolytica, and makes it an attractive potential starting point for effective treatments that reduce downstream amoebic liver abscess.

Purpose We present a patient with Bruton’s disease and bronchiectasis who developed renal AA amyloidosis. Case Report A 38year-old man was diagnosed with X-linked agammaglobulinemia (Bruton’ sd isease) when he was 3y ears old, and he has been treated with parenteral immunoglobulin since then. Eighteen years later, he was diagnosed with central pulmonary bronchiectasis by computerized tomography (CT). In 2008, he gradually developed anemia, edema of lower limbs, and loss of weight. Method and Results Laboratory studies revealed deterioration of renal function, normocytic normochromic anemia and nephrotic range proteinuria.HepatitisB and C and HIV serology were negative. Ultrasound and CT of abdomen were normal. A renal biopsy revealed deposits with positive PAS and Congo red staining in glomeruli, interstitium, and vessel’s walls. Immunohistochemistry showed positive staining of the A amyloid. Direct immunofluorescence was positive with thioflavin and showed focal and glomerular mesangial IgG deposits, suggesting renal AA amyloidosis. For 2 years the patient conducted pharmacological treatment and follow-up for the Nephrology department with poor prognosis and progression of renal function impairment. In January 2011 he began dialysis treatment with improvement, and he is currently on the waiting list for renal transplantation. Conclusion We present a patient with Bruton’s disease and bronchiectasiswhodeveloped renal AAamyloidosis afinding rarely reported.

To cite this article: Rodriguez del Rio P, Sanchez-Garcia S, Escudero C, Pastor-Vargas C, Sanchez Hernandez JJ, Perez-Rangel I, Ibanez MD. Allergy to goat’s and sheep’s milk in a population of cow’s milk–allergic children treated with oral immunotherapy. Pediatr Allergy Immunol 2012: 23: 128–132. Abstract Background: Cow’s milk oral immunotherapy (CMOIT) is a recognized treatment for persistent cow’s milk (CM) allergy. However, further data are necessary on tolerance to milk from other mammals. Objective: To describe the clinical and immunologic features of goat’s and sheep’s milk (GSM) allergy in patients who tolerated CM after CMOIT. Methods: Fifty-eight CM-allergic patients who successfully underwent CMOIT in our department were evaluated using skin prick test (SPT), specific immunoglobulin (Ig) E determination, enzyme-linked immunoassay (ELISA), and controlled oral challenge to assess allergy to GSM. Statistical analysis was carried out to identify markers of allergy to GSM. Results: Fifteen of 58 (25.9%) patients were allergic to either goat’s or sheep’s milk or to both, as confirmed by a controlled positive oral challenge. Forty-seven percent of all positive oral challenges were classified as anaphylactic reactions. Specific IgE to CM casein, goat’s whole milk, and sheep’s whole milk was 13.2, 18.0, and 21.4 kUA/l in the group of GSM-allergic patients and 6.6, 6.5, and 6.5 kUA/l in the GSM-non-allergic patients (p

SummaryBackground No studies have evaluated the potential of egg oral immunotherapy (egg-OIT) to induce sustained unresponsiveness after discontinuing therapy following short-term treatments. Objective We assessed the efficacy of short-course egg-OIT to induce sustained unresponsiveness. Methods Sixty-one egg-allergic children, 5 to 17 years old, with positive double-blind placebo-controlled food challenge (DBPCFC) to dehydrated egg white (EW) were randomized to receive egg-OIT (OITG) for 3 months (maintenance dose one undercooked egg every 48 hours) or to continue egg avoidance diet (control group, CG) for 4 months. Children who completed egg-OIT avoided egg for 1 month. At 4 months, both groups underwent a DBPCFC. OITG participants who passed this challenge were instructed to add egg to their diet ad libitum. Immune markers were studied at different time points. Results Ninety-three percent (28/30) of OITG children were desensitized in a median of 32.5 days (IQR, 14 days). At 4 months, 1/31 (3%) in CG passed DBPCFC and 11/30(37%) of OITG (95% CI, 14 to 51%; P = 0.003), all of them were consuming egg at 36 months. A decrease in EW, OVA and OVM skin test results and OVA-specific IgE (sIgE) levels was observed on OITG at 4 months (P = 0.001). EW-, OVA- and OVM-sIgE levels prior to the start of egg avoidance diet were lower in OITG children who passed DBPCFC at 4 months than in those who did not pass it. EW- and OVM-sIgE showed the best diagnostic performance in predicting DBPCFC result at 4 months. Levels above optimal EW-sIgE cut-off of 7.1 kU/L indicated 90% probability of failing DBPCFC. Conclusion This is the first demonstration of sustained unresponsiveness with a three-month egg-OIT protocol. Almost all treated subjects were desensitized and 37% achieved sustained unresponsiveness. EW-sIgE levels at the end of treatment predicted sustained unresponsiveness. This protocol shows a new approach to OIT for egg-allergic children.

Background Egg oral immunotherapy is effective but time consuming. Objective To assess the efficacy and safety of egg rush oral immunotherapy (ROIT) with a targeted dose equivalent to a raw egg white. Methods Thirty-three persistent egg allergic children confirmed by double-blind, placebo-controlled food challenge (DBPCFC) were randomized to receive egg ROIT immediately after randomization (ROIT1 group), or to continue an egg avoidance diet for 5 months after randomization (control group [CG]). A 5-day build-up phase starting with the highest single tolerated dose at baseline DBPCFC was scheduled and several doses administered daily until achieving a dose of approximately 2,808 mg of egg white protein. In the maintenance phase, patients ate an undercooked egg every 48 hours for 5 months. The CG participants who failed the DBPCFC at 5 months began active treatment. Children from the ROIT1 group plus children from the CG who failed a second DBPCFC at 5 months and then received egg ROIT were randomized to the ROIT2 group. Adverse events (AEs) and immune marker evolution were recorded. Results A total of 17 (89%) of 19 children in the ROIT1 group and no CG patients were desensitized at 5 months ( P Conclusion The proposed 5-day egg ROIT desensitized 94% of the allergic patients, with most AEs being mild or moderate.

[Background]: This paper reports the case of an egg-allergic pediatric patient who, once desensitized to egg following a successful rush oral immunotherapy protocol, could also tolerate Lizipaina®, a drug containing lysozyme (LYS) and papain, which had previously caused him a severe allergic reaction. Because the LYS amount that elicited the anaphylactic reaction (5 mg) was much lower than that tolerated during a double-blind placebo-controlled food challenge (corresponding to approximately 60 mg of LYS), the possibility that the presence of papain could increase the allergenic potential of LYS was investigated. [Methods]: Lizipaina, LYS and LYS hydrolyzed with papain were analyzed by SDS-PAGE under reducing and nonreducing conditions, and Western blotting of sera from egg-allergic patients was performed in order to detect IgE-binding fragments. Finally, sequence identification of the IgE-reactive bands was carried out by MALDI-TOF/TOF. [Results]: The SDS-PAGE pattern of LYS treated with papain under nonreducing conditions showed the presence of intact LYS that partially disappeared following reduction with β-mercaptoethanol, releasing IgE-reactive fragments as determined by Western blotting. MALDI-TOF/TOF revealed that papain degraded LYS, giving rise to three IgE-binding fragments: LYS (22-129), LYS (34-96) and LYS (62-128) that likely remained linked through the disulfide bonds present in the LYS molecule. Conclusion: The combined administration of LYS with proteolytic enzymes such as papain may have developed a severe allergic reaction in the patient studied, underlining the importance of considering all the components and their interactions when drugs are to be consumed by allergic persons., The authors acknowledge financial support from Fundación Salud 2000 (Merck-Serono, Spain) and ALK-Abelló Laboratories (Madrid, Spain), and by the project AGL2011-24740. S. B. and I.L.-E. acknowledge the financial support of CSIC through JAE-Pre and JAE-Doc grants, and D.L.-O. the financial support of the Ministerio de Educación, Cultura y Deporte through a FPU grant.

Background Raw and cooked eggs are used as allergens in oral food challenge (OFC). Raw egg is the best option, as it keeps proteins intact and retains their allergenicity, albeit microbiologically safe manipulation is difficult. Therefore, the use of dehydrated egg white (DEW) could improve the efficacy and safety profile of OFC. The aim of the study was to compare the allergenicity of DEW, a product that undergoes a double heat treatment (pasteurization and drying), with that of raw egg white (REW) and determine the efficacy of DEW in the diagnosis of egg allergy. Methods We conducted a prospective study of 40 egg-allergic patients who visited our outpatient clinic. Each patient underwent OFC with DEW and REW to determine the correlation between the tests. DEW and REW extracts were analyzed using SDS-PAGE. We compared the allergenicity of both extracts using IgE immunoblotting with a serum pool from patients with positive OFC results. Results Ten patients (25%) had positive OFC results with both DEW and REW, and the doses that triggered an allergic reaction in each patient were similar (p > 0.05). All 30 patients (75%) with a negative OFC result with DEW also had negative OFC results with REW. SDS-PAGE and IgE immunoblotting revealed that the protein composition and IgE-binding capacity of both extracts were virtually identical. Conclusions This is the first time that it is shown that the allergenicity of commercially available DEW is equivalent to raw egg whites. In vivo and in vitro tests showed that processing of DEW does not affect the allergenicity of egg proteins. DEW is an effective and microbiologically safer source of allergen for the diagnosis of egg allergy. Furthermore, DEW can be used in egg oral immunotherapy.

Candida glabrata is an opportunistic pathogen that is considered the second most common cause of candidiasis after Candida albicans Many characteristics of its mechanisms of pathogenicity remain unknown. Recent studies have focused on determining the events that underlie interactions between C. glabrata and immune cells, but the relationship between this yeast and osteoblasts has not been studied in detail. The aim of this study was to determine the mechanisms of interaction between human osteoblasts and C. glabrata, and to identify the roles played by some of the molecules that are produced by these cells in response to infection. We show that C. glabrata adheres to and is internalized by human osteoblasts. Adhesion is independent of opsonization, and internalization depends on the rearrangement of the actin cytoskeleton. We show that C. glabrata survives and replicates in osteoblasts and that this intracellular behavior is related to the level of production of nitric oxide and reactive oxygen species. Opsonized C. glabrata stimulates the production of IL-6, IL-8 and MCP-1 cytokines. Adhesion and internalization of the pathogen and the innate immune response of osteoblasts require viable C. glabrata These results suggest that C. glabrata modulates immunological mechanisms in osteoblasts to survive inside the cell.