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Aspirin-exacerbated respiratory disease (AERD) is a chronic inflammatory disease. It is defined by asthma, chronic rhinosinusitis with nasal polyposis, and a hypersensitivity reaction to aspirin or nonsteroidal anti-inflammatory drugs. Aspirin desensitization (AD) has been confirmed as an effective treatment to control AERD inflammation through the modulation of immune responses. We aimed to review AERD with an overview of the epidemiology, pathophysiology, and treatment. We also discussed the effect of AD on immunological markers involved in AERD pathogenesis. A search of electronic databases on AERD was performed. We included five randomized clinical trials (RCTs) on AD. We also searched databases for recent studies that investigated the effect of AD on the immunological mechanisms of AERD. RCTs have demonstrated the therapeutic effectiveness of AD on the patients’ quality of life, asthma symptom score, inhaled and oral steroid use, forced expiratory volume in 1 sec (FEV1), and inflammatory mediators. The clinical benefits of AD can occur though the regulation of innate and adaptive immune responses that are involved in the pathogenesis of AERD. In addition to the valuable effects of AD in RCTs, some side effects such as gastrointestinal bleeding, asthma exacerbation, or rash have been reported that should be considered for reaching an optimal protocol for AD.

A novel coronavirus disease known as Coronavirus Disease 2019 (COVID-19) has spread quickly throughout the world, and it was declared a pandemic in March 2022. Chronic granulomatous disease (CGD) is a diverse group of genetic disorders characterized by recurrent bacterial and fungal infections, resulting in granulomas due to the inability of phagocytes to destroy microbes. Even though it is thought that impaired neutrophil activity is a protective mechanism against severe COVID-19-induced cytokine storms and hyper-inflammatory responses, patients with CGD have normal immunity to most viruses. Here, we present two CGD patients who were hospitalized due to severe COVID-19 infections, which suggests that COVID-19 might have a different pathogenesis than other viruses.

A decrease in T cell count or reduced T cell function can be indicative of T cell immunodeficiency. In the present study, T-cell function was assessed using Carboxyfluorescein diacetate succinimidyl ester (CFSE) dilution test after stimulation with commonly used Phytohaemagglutinin (PHA) or anti-CD3/anti-CD28 coated beads in pediatric patients with recurrent infections. Seven infants with recurrent infections and seven sex/age-matched healthy infants were included in this study. A blood cell count, immunophenotyping, and serum immunoglobulin level were performed. The proliferation of T cells was also assessed with CFSE dilution after stimulation with PHA or anti-CD3/anti-CD28 coated beads. This study showed increased IgA, IgG, and IgM levels in patients compared to the controls. In contrast to the controls, the immunophenotyping results showed a significant decline in the number of CD4+ T cells in patients. Although there was no difference in CD3+ T cell proliferation between patients and controls, the CD4+ and CD8+ T cell proliferation rates were significantly decreased in patients when stimulated with PHA. As a mitogen with the potential for maximum proliferation of T cells, PHA is better able to distinguish between patients with recurrent infections and controls than anti-CD3/anti-CD28, which mimics only the TCR pathway for stimulation of T cells.

Pollens have been identified as potent inducers of allergic diseases worldwide. Acer velutinum (Persian maple) tree is an important source of allergic pollens in Iran. This study aimed to identify the immunoglobulin E (IgE)-reactive components of A. velutinum pollen extract in patients with maple allergy. We aimed to evaluate its allergenic components; using IgE in the serum of patients with maple allergy. Twenty-two patients with a clinical history of reaction and a positive skin-prick test to maple pollen extract were included in this study. Identification of IgE-binding proteins in A. velutinum pollen extract was performed by immunoblotting using sera from sensitive patients. A protein band with a molecular weight of around 70 kDa was the most IgE-reactive allergen in A. velutinum pollen extract detected by this method. Identification of a protein with a molecular weight of about 70kDa, as the most reactive allergen of A. velutinum pollen extract, can be considered as a potential allergen for designing diagnostic kits or as a target for immunotherapy of allergic patients with maple allergy.

Airborne pollen is considered one of the causative agents of hay fever, allergic rhinitis, conjunctivitis, and asthma. We aimed to investigate airborne pollens in the context of Shiraz located in the southwest of Iran and find their association with meteorological parameters. The survey was conducted from October 2017 to September 2018, using seven days of volumetric Burkard spore trap, located in the center of the city. A total of 5810 pollen grains/m3 belonging to 15 taxa were identified and recorded. Among them, 73.8% was the tree, while the grass, shrub, and weed constituted 13.56%, 3.5%, and 9.2% of total reported pollens, respectively. The major pollen types were Platanaceae (28.39%), Oleaceae (21.17%), Pinaceae (15.11%), Amaranthaceae (9.29%), and Brassicaceae (8.02%). A higher number of pollen counts and types were recorded in March, followed by September, while it was lower in May. Meteorological parameters were correlated with the monthly pollen counts. Wind speed was found to have a positive correlation with Platanaceae concentration. The significant correlation between pollen concentration and the temperature was positive for Poaceae, Amaranthaceae, and Plantaginaceae and negative for Rosaceae, Oleaceae, and Ulmaceae. Poaceae and Amaranthaceae were negatively correlated with humidity and positively with Rosaceae, Oleaceae, and Plantaginaceae. A negative correlation was found between rainfall and Poaceae and Amaranthaceae, while Plantaginaceae had a positive correlation with this parameter. The results of this study may be helpful for allergologists in the diagnosis and treatment of airborne allergic disorders due to pollen grains.

Bacillus Calmette Guerin (BCG) was designed for protecting children against tuberculosis. Also, it can protect against other infectious diseases through the induction of trained immunity. Due to its heterologous protective effects, the BCG vaccine has been proposed as atreatment option for coronavirus disease-2019 (COVID-19). Epidemiological studies have found that countries without BCG vaccination policy have experienced higher mortality rates related toCOVID-19 infection than those with BCG vaccination policy. However, there are some confounding factors such as age, population intensity, immigration, the pandemic phase, and data accuracy that may affect these results. Therefore, this hypothesis should be evaluated by clinical trial studies. Large-scale clinical trials are in progress to investigate ifthe BCG vaccine could be used as a useful tool for protection against COVID-19 infection.

The prevalence of primary immunodeficiency (PID) is rather high in Iran compared to the world average, mainly due to the high rate of consanguineous marriage. Despite that, little genetic information is available about primary immunodeficiencies in Iran. Autosomal recessive hyper IgE syndrome (AR-HIES) is a severe type of immunodeficiency, mainly caused by mutations in the dedicator of cytokinesis 8 (DOCK8). Rapid and precise diagnoses of patients suffering from AR-HIES can help to manage the patients and reach properly the treatment decision. However, in regions with low financial resources and limited expertise, deep phenotyping is uncommon. Therefore, an exome-first approach is helpful to make a genetic-based diagnosis. In the present study, whole-exome sequencing (WES) was applied to detect causative mutations in three unrelated primary immunodeficient patients with poor clinical information. One of the cases was a deceased patient with suspected hyper IgE syndrome (HIES) whose parents were subjected to WES. As a result, three novel pathogenic variants were detected in the DOCK8 gene, including two splicing sites (c.4241+1G>T and c.4886+1G>T) and one-stop-gain (c.4201G>T, p.Glu1401Ter) variants. Sanger sequencing confirmed the mutations’ segregation in corresponding families. Further immunological investigations confirmed that HIES in the studied probands. The presence of frontal bossing and broad nose in one of the studied cases, in addition to the typical clinical presentation of DOCK8-AR-HIES, is notable. This work suggests that an exome-first approach can be a valuable alternative strategy for precise diagnosis of primary immunodeficiency patients.

Allergic rhinitis is one of the most common health problems with a major effect on the quality of life. We intended to treat Allergic Rhinitis (AR) in patients who are either unresponsive to antihistamines or their job requires optimal alertness that may be disturbed by antihistamine’s side effects and those who do not comply with the regular use. We tried short term phototherapy and evaluated its effect on AR. As phototherapy is effective in the treatment of atopic dermatitis (AD) and the same allergens can produce both AD and AR, phototherapy is proposed as a new tool in the AR treatment. In AD, phototherapy causes induction of apoptosis in infiltrating T cells and other immunomodulatory effects. We performed a randomized single-blind study to investigate the effect of low-dose phototherapy in AR patients. Among AR patients who did not respond to local and systemic therapy, we chose 62 allergic patients all above 25 years of age with moderate to severe AR whose disease was verified by allergy skin test or specific IgE to allergens; then, they were randomly divided into 31 patients as treatment group and 31 patients as control group. In treatment groups, we used a mixture of UVA, UVB and visible light. In the control group, we used visible light alone as placebo. Then we evaluated the level of response to treatment in two groups and compared them according to Total Nasal Symptom scores (TNSS) and Global Severity Scores (GSS) and Rhinoconjunctivitis Quality of Life Questionnaires (RQLQ) symptom scores. We found out that phototherapy in the treatment group in comparison with placebo was effective in treatment of AR (p-value

Limited evidence has been obtained concerning the beneficial effects of autologous serum therapy in treatment of skin disorders particularly chronic urticaria. In the present study, we have assessed the effect of this treatment method in patients with chronic urticaria (CU). This randomized single-blind controlled trial was performed on fifty consecutive patients with chronic urticaria. The patients were randomly assigned to receive autologous serum (as the case group, n=35) or normal saline (as the control group, n=15) and treated with monthly autologous serum therapy or normal saline for 6 months. The considered study endpoint was changes in total severity score (TSS) at the 6 months follow-up visit. The TSS score was assessed at baseline as well as at the ninth week and the sixth month of interventions. The mean±SD of TSS at the ninth week of intervention was 10.94±3.92 in autologous serum therapy group and 11.67±2.72 in the normal saline group (p=0.458). Furthermore, the mean values of TSS at the sixth month of treatment in the study groups were 8.29±6.29 and 9.27±4.89 respectively (p=0.593). A downward trend in TSS, from baseline to the end of treatment, was seen in the case and control groups (p

Inflammation of blood vessels is a characteristic feature of Kawasaki disease. Neutrophils play a key role in the inflammatory responses where movement of neutrophils toward the site of inflammation depends on CD11b/CD18 expression as adhesion molecules on these cells. The purpose of this study was to investigate CD11b/CD18 expression in patients with Kawasaki disease upon diagnosis and after treatment. The study included 20 children with Kawasaki disease aged from 3 months to 8 years. Mean fluorescence intensity of CD11b levels on diagnosis and at 1-2 and 6 weeks after intravenous immunoglobulin (IVIG) therapy was measured in these patients. Level of CD11b was measured in age-matched healthy children and febrile children (each 21) as negative and positive controls, respectively. Mean fluorescence intensity of CD11b in Kawasaki patients was lower than that of the control groups before and after 1-2 weeks of IVIG therapy. There were no significant differences in CD11b in Kawasaki patients either with aneurysm or without aneurysm. The CD11b levels at the diagnosis time and after treatment with IVIG in our patients with Kawasaki were lower than the control groups.

Recent studies have proposed that a decline in bacterial infections such as tuberculosis is a factor underlying the rising prevalence and severity of atopic disorder in developed countries. There are conflicting ideas about the inverse relationship between BCG (Bacillus Calmette-Guerin) vaccination and asthma. Stronger response to tuberculin test as an indicator of more potent TH1 response is supposed to influence TH2 modulated allergic reactions. BCG scar considered as an indicator of TH1 - immunoresponse has been proposed to be smaller in asthmatic children in some studies. In a case-control study, 97 asthmatic and 97 control children younger than 5 years of age and BCG vaccinated at birth were tested with 5 units of tuberculin intradermaly. After 48-72 hours, the indurated area was measured in two diameters. Mean while, the scar of BCG in both groups was measured. Severity of asthma in the case group was recorded and categorized into mild, moderate and severe groups. The case group consisted of 63% boys and 37% girls and their tuberculin response was significantly smaller than that of the control (p=0.000), but no data supported the inverse relationship between the tuberculin response and severity of asthma (p=0.113). The scar of BCG was not significantly different in the asthmatic children with variable severity of asthma and control group (p=0.864). Children with definite asthma had a significant weaker response to tuberculin. This might be an indication of less potent TH1-reponse in allergic patients, but it was not associated with severity of asthma. No significant relationship between the size of BCG scar and asthma or its severity was found so perhaps BCG scar is not a sensitive indicator for development of asthma in future.

Allergic rhinitis is the most common cause of allergic diseases. The recent guidelines of Allergic Rhinitis and its Impact on Asthma (ARIA) group, classified it to intermittent (less than 4 days per week and for less than 4 weeks) and persistent (more than 4 days per week or lasting more than 4 weeks regardless of the number of days per week). The present study evaluates the patients with ARIA classification. The patients referred to Motahhari Clinic (Shiraz, Iran) were evaluated. Age, sex, seasonal or perennial, intermittent or persistent type, duration, sneezer or blocker, diurnal change and presence of allergic conjunctivitis were recorded. The patients who had one or more symptoms of; impairment of sleep, daily activity or work in school or troublesome symptoms had moderate to severe disease and those who did not have these problems have mild disease. The information of 96 patients (46 male and 50 female) were analysed (mean ageSD: 24.4510.37 years). The mean duration of disease was 4.264.12 years, was more in female (P

Asthma is the most common chronic respiratory disease of children in the world. Serial studies in the world have showed an increased prevalence of bronchial asthma. In this study, the children younger than 12 years old referred to Jahrom hospital and clinic due to asthma were selected. We issued 100 questionnaires, according to International Study of Asthma and Allergies in Childhood (ISAAC) criteria and were completed by the physicians. The ratio of male to female was 1 to 9. The patients who were under the age of 4, 3 and 1 year were 82%, 60% and 15% respectively. Passive smoking was present in 56% of the patients, and 22% had pets at home like cat, dog or bird. Home dampness was present in 33%. Ninety percent of patients had used breast feeding during the first year of life. Seventy percent of patients had family history of asthma. Food allergy was present and could trigger asthma in 15%. The result of ISSAC questionnaire showed that during the last year wheezing was present in 10%, 6% had 1-3 attacks and 4% had 4-12 attacks. Sleep disturbance by wheezing had occurred in 5% but cough in 16%. Thirteen percent of patients had wheezing after exercise. In Jahrom town the climate is warm and dry. In this town asthma in children is more common among the children who are younger than 4 years old. The risk factor like smoking at home, pets and home dampness should be eliminated from their environment.

Churg-Strauss Syndrome (CSS) is a small vessel granulomatous vasculitis that characteristically affects the middle age group and is extremely rare in children. We describe an 8-year-old girl with a prolonged history of cough and eosinophilia that initially was labeled as pulmonary tuberculosis, but after complementary assays, associated with skin biopsy, eosinophilic fibrinoid vasculitis, CSS was eventually diagnosed. In this case, due to her young age and more prevalence of infectious lung diseases in our area, there was a few months delay for correct diagnosis and treatment. After meeting the CSS criteria the appropriate treatment was started and her condition improved.

Theophylline, (1,3-dimethylxanthine) is widely used as a smooth muscle relaxant, myocardial stimulant and a diuretic agent. The most frequent use of theophylline is in treatment of acute and chronic asthma as a bronchodilator. To determine the effect of Theophylline on serum electrolyte and uric acid, 21 asthmatic children (age range 1,5-7 years) with severe acute asthma and 25 patients with chronic asthma (5-15 years ) who were being treated with slow-release theophylline were enrolled in this study. Fifty age and sex matched normal children took part as control. Blood samples (5ml) were withdrawn before, during and after completion of the course of intravenous theophylline treatment (0.05-0.70 mg/kg/ hr). Sera obtained were used for analysis of K+, Na+, phosphorus, calcium and uric acid by RA-1000 automated analyzer and the following results were obtained: (1) After treatment, total serum calcium in acute asthmatic patients decreased significantly compared with controls (P