Julie Leysen

Increased IL-17 production by peripheral T helper cells after tumour necrosis factor blockade in rheumatoid arthritis is accompanied by inhibition of migration-associated chemokine receptor expression

OBJECTIVES The contribution of IL-17-producing Th17 cells to the pathogenesis of T-cell-mediated inflammatory disorders such as RA and atopic dermatitis (AD) has to be viewed in relation to the role of Th1/Th2 cells and long-recognized key cytokines like TNF. We aimed to study the frequency and migration-associated phenotype of peripheral Th17, Th1 and Th2 cells in healthy individuals, RA and AD patients, and to study the influence of anti-TNF therapy in RA. METHODS Intracellular IL-17, IFN-γ and IL-4 production and CC-chemokine receptor CCR4 and CCR6 expression were analysed flow cytometrically in peripheral memory Th cells from healthy individuals, AD and RA patients. The latter were grouped by disease activity and presence or absence of adalimumab therapy. In RA patients initiating anti-TNF therapy, cytokine production by in vitro-stimulated peripheral mononuclear cells was measured by cytometric bead array. RESULTS The peripheral Th17 cell frequency is elevated in AD but not in RA. In RA, Th17 cells and IL-17 production increase after anti-TNF therapy, irrespective of disease activity. Th1 cells and IFN-γ production are elevated in remission and under anti-TNF therapy. CCR6 expression is up-regulated in Th17 cells, but RA patients in remission under anti-TNF therapy have significantly lower expression than those with active disease. CONCLUSIONS The increase in peripheral Th17 cells in RA patients after anti-TNF therapy is accompanied by a decrease in Th17-specific CCR6 expression, which might prevent homing of these potentially pro-inflammatory cells to the synovium.

Allergy to rocuronium: from clinical suspicion to correct diagnosis.

To cite this article: Leysen J, Bridts CH, De Clerck LS, Vercauteren M, Lambert J, Weyler JJ, Stevens WJ, Ebo DG. Allergy to rocuronium: from clinical suspicion to correct diagnosis. Allergy 2011; 66: 1014–1019.

Component‐resolved diagnosis of wasp (yellow jacket) venom allergy

Wasp venom allergy is a potentially life‐threatening condition with serious consequences of diagnostic error.

The basophil activation test in the diagnosis of immediate drug hypersensitivity

Hypersensitivity reactions to drugs account for 15% of all adverse drug reactions and represent an important health problem with significant morbidity and mortality. This article describes the current applications and perspectives of the basophil activation test by flow cytometry in the diagnosis of immediate-type drug allergy, with particular focus on its diagnostic performance in allergy to neuromuscular blocking agents, antibiotics and NSAIDs and on future applications.

IgE-mediated allergy to pholcodine and cross-reactivity to neuromuscular blocking agents : lessons from flow cytometry

Immunoglubulin E antibody‐mediated allergic reactions to opioids are rare and difficult to document correctly.

Rocuronium-induced anaphylaxis is probably not mitigated by sugammadex: evidence from an in vitro experiment

of side-effects, having taken into account that the action of rocuronium is markedly prolonged in elderly patients with renal failure [2]. Sugammadex has effectively reversed moderate rocuronium-induced neuromuscular blockade in patients with renal failure [3]. If re-intubation is required after reversal of neuromuscular blockade with sugammadex, re-onset of block following rocuronium administration may be delayed but can be successfully re-introduced within 5 min after sugammadex administration [4]. We wanted to emphasise in our letter that reversal of neuromuscular block with sugammadex might cause prolonged impairment of the action of steroidal neuromuscular blocking drugs in concurrent surgical procedures, especially in the presence of renal insufficiency. Administration of sugammadex needs to be well documented and information should be transferred personally from one anaesthetic team to the next to prevent unexpected failure of neuromuscular blockade. Furthermore, in the absence of renal function, the fate of the rocuronium-sugammadex complex is still unclear and needs to be clarified in further studies.

Predictive value of allergy tests for neuromuscular blocking agents: tackling an unmet need

Neuromuscular blocking agents (NMBAs) are a predominant cause of perioperative anaphylaxis in Europe. Diagnosis of NMBA allergy relies upon the careful review of the anaesthetic report complemented with skin tests. Additional diagnostic tests are quantification of specific IgE antibodies (sIgE) and basophil activation test (BAT). However, data on the predictive value of the skin tests, the BAT and the sIgE assays (drug‐specific and substituted ammonium structures) are limited or not available, mainly because such exploration requires dangerous NMBA provocation tests.

Basophilic histamine content and release during venom immunotherapy: insights by flow cytometry.

Despite the efficiency of venom immunotherapy, the effects on basophils and mast cells remain incompletely understood and probably vary according to the treatment phase.

SENSITIZATION TO THE MAMMALIAN OLIGOSACCHARIDE GALACTOSE-ALPHA-1,3- GALACTOSE (ALPHA-GAL): EXPERIENCE IN A FLEMISH CASE SERIES

Abstract Background. Recent observations have disclosed that the galactose-α(1,3)-galactose (α-gal) moiety of non-primate glycoproteins can constitute a target for meat allergy. Objective. To describe adults with allergic reactions to mammalian meat, dairy products and gelatin. To investigate whether patients could demonstrate sensitization to activated recombinant human coagulation factor VII ectapog alpha that is produced in baby hamster kidney cells. Methods. Ten adults with mammalian meat, dairy products and gelatin allergies were examined using quantification of specific IgE and/or skin prick test for red meat, milk, milk components, gelatin, cetuximab and eptacog alpha. Results. Most patients demonstrate quite typical clinical histories and serological profiles, with anti-α-gal titers varying from less than 1% to over 25% of total serum IgE. All patients demonstrate negative sIgE for gelatin, except the patient with a genuine gelatin allergy. All patients also demonstrated a negative sIgE to recombinant milk components casein, lactalbumin and lactoglobulin. Specific IgE to eptacog was positive in 5 out of the 9 patients sensitized to α-gal and none of the 10 control individuals. Conclusion. This series confirms the importance of the α-gal carbohydrate moiety as a potential target for allergy to mammalian meat, dairy products and gelatin (oral, topical or parenteral) in a Flemish population of meat allergic adults. It also confirms in vitro tests to mammalian meat generally to be more reliable than mammalian meat skin tests, but that diagnosis can benefit from skin testing with cetuximab. Specific IgE to gelatin is far too insensitive to diagnose α-gal related gelatin allergy. IgE binding studies indicate a potential risk of α-gal-containing human recombinant proteins produced in mammalians.

Polyhexamethylene biguanide is a relevant sensitizer in wet wipes

Polyhexamethylene biguanide (PHMB; CAS no. 2875743-3) is a preservative used as a biocide in industrial products (e.g. swimming pool disinfectants), medical devices (e.g. wound cleansers), contact lens solutions, and cosmetics such as wet wipes, deodorants, and facial cleansers. It is considered to be a rare contact allergen, with a sensitization rate of ∼ 0.5% in an unselected population (1, 2). Moreover, sensitization does not seem to be associated with cosmetic exposure (2). Here, we report a case of allergic contact dermatitis following the use of wet wipes containing PHMB.