Kicked to touch: Hoodwinked by torticollis

A 2-year-old girl presented to the emergency department with a 3-day history of a painful stiff neck after getting a kick to her head from her older brother. Her general practitioner had recently started her on oral antibiotics for otitis media. Plain film imaging of her cervical spine on admission revealed anterior subluxation of C2 on C3 suggestive of bifacetal dislocation. Subsequent CT imaging confirmed malalignment of the upper cervical spine. The patient was admitted and worked up with MRI of the cervical spine which unexpectedly revealed a large 4x2 cm retropharyngeal abscess extending from C1 to C4. No associated structural abnormality of the spine was detected. This case report highlights the life-threatening causes of torticollis (retropharyngeal abscess and cervical spine injury), and summarises the anatomy and normal variants that one should expect on interpretation of cervical spine imagery.

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Prevention of food allergy development and suppression of established food allergy by neutralization of TSLP, IL-25 and IL-33

Publication date: Available online 26 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marat V. Khodoun, Sunil Tomar, Joel E. Tocker, Yui Hsi Wang, Fred D. Finkelman
BackgroundFood allergy (FA) is an increasing problem that has no approved treatment. The pro-Th2 cytokines, IL-25, IL-33 and TSLP, are associated with FA and monoclonal antibodies (mAbs) to these cytokines are reported to suppress murine FA development.ObjectiveDetermine whether anti-pro-Th2 cytokine mAbs can block both FA maintenance and induction.MethodsIgE-mediated FA was induced in BALB/c mice by oral gavage (o.g.) with medium chain triglycerides plus egg white (MCT/EW) and was characterized by increased numbers of lamina propria Th2 cells, mast cells shock, and eosinophils, shock (hypothermia), mast cell degranulation (increased serum MMCP1), increased serum IgG1 anti-EW and IgE, and increased IL-4 and IL-13 secretion following MCT/EW challenge. To suppress FA development, mice were injected with anti-IL-25, IL-33R, and/or TSLP monoclonal antibodies prior to the initial o. g. with MCT/EW; to suppress established FA, treatment with the same mAbs was initiated after FA development.ResultsInjection of a mAb to IL-25, IL-33R, or TSLP strongly inhibited FA development. No single mAb to a pro-Th2 cytokine could suppress established FA and optimal FA suppression required treatment with a cocktail of all three anti-pro-Th2 mAbs. Treatment with the three mAb cocktail during initial MCT/EW immunization induced EW tolerance.ConclusionAll of the pro-Th2 cytokines are required to induce our model of FA, while any pro-Th2 cytokine can maintain established FA. Pro-Th2 cytokines prevent oral tolerance. Combined treatment with antagonists to all three pro-Th2 cytokines or with an inhibitor of pro-Th2 cytokine production may be able to suppress established human FA.

Teaser

IL-25, IL-33 and TSLP are required to induce a mouse model of food allergy and all of these cytokines contribute to murine food allergy maintenance. This suggests an approach for suppressing human food allergy.


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Hematopoietic Stem Cell Transplantation For RelB Deficiency

Publication date: Available online 26 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Adi Ovadia, Yael Dinur Schejter, Eyal Grunebaum, Vy Hong-Diep Kim, Brenda Reid, Tal Schechter, Elena Pope, Chaim M. Roifman
HSCT conditioning is tolerated well by patients with RelB deficiency and leads to immune reconstitution.



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ImmunoCAP Assays: pros and cons in allergology

Publication date: Available online 25 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marianne van Hage, Carl Hamsten, Rudolf Valenta
Allergen-specific IgE measurements together with the clinical history are the cornerstones of allergy diagnosis. During the past decades not only characterization and standardization of allergen extracts have improved but also assay technology. Here we discuss the uses, advantages, misinterpretations and limitations of ImmunoCAP IgE assays (Thermo Fisher Scientific/Phadia, Uppsala, Sweden) in the field of allergology. They can be performed as singleplex (ImmunoCAP) and since a decade also as multiplex (ISAC). The major benefit of ImmunoCAP is the obtained quantified allergen-specific IgE antibody level and the lack of interference from allergen-specific IgG antibodies. However, ImmunoCAP allergen extract are limited to the composition of the extract. The introduction of allergen molecules has had major impact on the analytical specificity and allergy diagnosis. They are utilized in both singleplex ImmunoCAP and multiplex ImmunoCAP ISAC assays. The major advantage of ISAC is the comprehensive IgE pattern obtained with a minute amount of serum. The shortcomings are its semiquantitative measurements, lower analytical sensitivity and cost per assay. With respect to assay performance ImmunoCAP allergen extracts are good screening tools, but allergen molecules dissect the IgE response on a molecular level and put allergy research on the map of precision medicine.



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Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial

Publication date: Available online 26 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Eve Hornsby, Paul E. Pfeffer, Nancy Laranjo, William Cruikshank, Marina Tuzova, Augusto A. Litonjua, Scott T. Weiss, Vincent J. Carey, George O'Connor, Catherine Hawrylowicz
BackgroundProgramming of the immune system during fetal development can influence asthma-related risk factors and outcomes in later life. Vitamin D is a well-recognized immune modulator, and deficiency of this nutrient during pregnancy is hypothesized to influence disease development in offspring.ObjectiveWe sought to investigate the effect on neonatal immunity of maternal supplementation with 4400 IU/d vitamin D3 during the second and third trimesters of pregnancy by using a subset of cord blood samples from a randomized, double-blind, placebo-controlled clinical trial (the Vitamin D Antenatal Asthma Reduction Trial).MethodsCord blood samples from neonates born to mothers supplemented with 4400 IU/d (n = 26) or 400 IU/d (n = 25) of vitamin D3 were analyzed for immune cell composition by flow cytometry, Toll-like receptor (TLR) expression by quantitative PCR, and cytokine secretion after stimulation with mitogenic, TLR, and T-cell stimuli by cytometric bead array. Responsiveness to the glucocorticoid dexamethasone was determined.ResultsSupplementation of mothers with 4400 IU of vitamin D3 resulted in an enhanced broad-spectrum proinflammatory cytokine response of cord blood mononuclear cells to innate and mitogenic stimuli (P = .0009), with an average 1.7- to 2.1-fold increase in levels of several proinflammatory cytokines (GM-CSF, IFN-γ, IL-1β, IL-6, and IL-8) across stimuli, a higher gene expression level of TLR2 (P = .02) and TLR9 (P = .02), a greater than 4-fold increase in IL-17A (P = .03) production after polyclonal T-cell stimulation, and an enhanced IL-10 response of cord blood mononuclear cells to dexamethasone treatment in culture (P = .018).ConclusionVitamin D exposure during fetal development influences the immune system of the neonate, which can contribute to protection from asthma-related, including infectious, outcomes in early life.

Graphical abstract

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In Memory and Celebration: Dr. James J. Lee

Abstract

We come together to mourn the untimely passing of Dr. James (Jamie) J. Lee, Professor of Biochemistry and Molecular Biology in the Division of Pulmonary Medicine at Mayo Clinic Arizona. A leading scientist, talented teacher, prominent role model, and Eosino-philosopher-in-Chief, Jamie's many enthusiasms and joy for science inspired us all. Together with his wife and research partner, Dr. Nancy Lee, Jamie's academic career was dedicated to improving our understanding of eosinophils and to exploring their contributions to chronic respiratory diseases and cancer.

This article is protected by copyright. All rights reserved.

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Maggots in the management of ulcer care

Description

An elderly man was admitted to the hospital with right leg mixed aetiology ulcers and superadded cellulitis, which had been unresponsive to several weeks of oral antibiotic therapy (figure 1). He was an ex-smoker with a medical history of hypertension, atrial fibrillation and previous cerebrovascular event and was treated with intravenous antibiotics for superadded infection. Surgical debridement was undertaken with little success (figure 2). He was offered biological debridement therapy using contained maggots, to which he responded very well and was discharged home after 1 month. (figures 3 and 4)

Figure 1

Image showing right leg mixed aetiology ulcers and superadded cellulitis.

Figure 2

Image showing right leg postsurgical debridement therapy.

Figure 3

Image showing right leg postbiological maggot debridement therapy.

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