J.F. Mowbray

Linear IgA disease in adults

A multi‐centre study is described in which thirty‐five adult patients with papillary IgA dermatitis herpetiformis (DH) were compared with forty‐two patients with linear IgA deposits, of whom thirty‐four had homogeneous‐linear (HL) and eight had granular‐linear (GL) IgA deposits.

DETECTION OF CIRCULATING IMMUNE COMPLEXES IN PATHOLOGICAL HUMAN SERA

The results of attempts to detect circulating immune complexes in sera by two methods are described. Both rely on the binding of the first complement component (C1) to the complex for its detection. The results, using these methods, of attempts to show which patients have complexes which contain nucleic acid and hence possibly viral antigens in the complexes are discussed. The anti-complementary complexes found in some patients seem to be associated with immune-complex vascular disease.

Outcome of pregnancies progressing beyond 28 weeks gestation in women with a history of recurrent miscarriage.

Ninety‐seven women who had had three or more miscarriages had also had at least one pregnancy with a singleton birth that had reached 28 weeks gestation. Information was available on these 118 babies; 30% were small‐for‐gestational age (birthweight ≤ 10th centile using figures from Scotland 1973–79), 28% were born preterm, and the perinatal mortality rate (excluding babies of <28 weeks gestation) was 161/1000 births, all of which are significantly increased above the prevalence for a normal obstetric population. These observations may serve to alert the clinician to the increased risk of these complications when dealing with women who have a history of recurrent miscarriage.

ALTERNATE-PATHWAY COMPLEMENT FIXATION BY IgA IN THE SKIN IN DERMATITIS HERPETIFORMIS

Abstract 34 samples of skin from nineteen patients with dermatitis herpetiformis (D.H.) were examined for the presence of IgA, IgG, and IgM and the Clq and C3 components of complement. IgA was present in all specimens but IgM was present in only 9 and IgG in 3. C3 was found in 16 (47%) of the specimens. The highest frequency was in the subgroup of specimens taken from early lesions (8 out of 9). However, C3 was also found in the 3 of 9 specimens of uninvolved skin from patients not receiving treatment, in 2 of 8 specimens from patients whose rash was controlled by dapsone, and in three of eight patients whose rash was controlled by a gluten-free diet. Clq was present in only 3 (9%) of the 34 samples; in 1 IgG was present and in 2 IgM. These results suggest that IgA activates complement by the alternate pathway in D.H. and that dapsone does not block this process.

80% of patients with intrinsic asthma are homozygous for HLA W6. Is intrinsic asthma a recessive disease?

Of 26 patients with intrinsic asthma, 21 (81%) were homozygous for the histocompatibility antigen HLA-W6. Also, half the patients had complement defects, in particular low levels of C2. This is the first indication of a strong genetic component in intrinsic asthma, apart from that already known from family studies. These findings suggest that intrinsic asthma may be a recessive disease.

SIGNIFICANCE OF HÆMATURIA IN HYPERTENSIVE PATIENTS

Of 409 patients attending a clinic for control of hypertension, 74 (18%) were found to have haematuria, and all those with haematuria had significant renal impairment. The association of raised serum IgA levels and HLA BW35 in these patients suggests that some have the adult form of the IgA/C3 disease described in children.