Immunology, systemic lupus erythematosus

Immunologic Systemic lupus erythematosus with an increase in anti-double-strand DNA antibodies has been attributed to ethosuximide [104" ]. 

Immunological abnormalities were reported in 23 adults in Woburn, Massachusetts, who were exposed to contaminated well water and who were family members of children with leukemia (Byers et al. 1988). These immunological abnormalities, tested for 5 years after well closure, included persistent lymphocytosis, increased numbers of T-lymphocytes, and depressed helper suppressor T-cell ratio. Auto-antibodies, particularly anti-nuclear antibodies, were detected in 11 of 23 adults tested. This study is limited by the possible bias in identifying risk factors for immunological abnormalities in a small, nonpopulation-based group identified by leukemia types. Other limitations of this study are described in Section 2.2.2.8. A study of 356 residents of Tucson, Arizona, who were exposed to trichloroethylene (6-500 ppb) and other chemicals in well water drawn from the Santa Cmz aquifer found increased frequencies of 10 systemic lupus erythematosus symptoms, 5 (arthritis, Raynaud s phenomenon, malar rash, skin lesions related to sun exposure, seizure or convulsions) of which were statistically significant (Kilbum and Warshaw 1992). 

Pathophysiologically, there is little difficulty in recognizing disseminated intravascular coagulation and then treating this on merit. Much more frequent are immunologically mediated mechanisms that may be secondary to underlying collagen-vascular diseases such as systemic lupus erythematosus or where the defect exists in isolation and the process is defined as primary, idiopathic or autoimmune. 

C8. Cervera, R., Khamashta, M. A., Font, J., Sebastiani, G. D., Gil, A., et al Systemic lupus erythematosus Clinical and immunologic patterns of disease expression in a cohort of 1,000 patients. The European Working Party on Systemic Lupus Erythematosus. Medicine 72, 113— 124 (1993). 

H12. Harisdangkul, V., McDougal, J. S., and Christina, C. L., Naturally occurring low molecular weight IgM in patients with rheumatoid arthritis, systemic lupus erythematosus, and macroglobulinemia. I. Purification and immunologic studies. J. Immunol. 115, 216-... 

H34. Huston, K. A., Gupta, R. C., Donadio, J. V., McDuffie, F. C., and Ilstrup, D. M., Circulating immune complexes in systemic lupus erythematosus Association with other immunologic abnormalities but not with changes in renal function. J. Rheum. 5,423-432 (1978). 

There is indirect evidence of sex differences in immunology. Women have a higher incidence of autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. The influence of sex hormones on the immune system may provide insight into these immunological disorders. For example, estrogen stimulates both humoral and cell-mediated immunity, whereas testosterone has the opposite effect (126). Therefore, it is not surprising that there is sex-dependent variability in response to immunosuppressive agents. 

Like other NSAIDs, suhndac can cause aseptic meningitis in patients with systemic lupus erythematosus (SEDA-7, 109). Recurrent aseptic meningitis, described in a patient with no underlying connective tissue disease who had tolerated other NSAIDs, suggested immunological hypersensitivity to sulindac (10). 

Humans with deficient IFNy response show several immunological defects, such as increased susceptibility to infections with intracellular pathogens. Impaired IFNy production has been demonstrated in human pathological conditions, namely chronic mucocutaneous candidiasis and systemic lupus erythematosus. ... 

Kidney diseases, autoimmune. May be due to immunological reaction to renal antigens ( - glomerular basal membrane, Goodpasture disease/syndrome) or part of systemic autoimmune disease (e.g. systemic lupus erythematosus, ANCA-associated vasculitides). 

The main safety issues for DNA vaccines include integration of the plasmid into the host genomic DNA, production of pathogenic anti-DNA antibodies to the plasmid that could induce or exacerbate diseases such as systemic lupus erythematosus, or immunologic tolerance to the antigen being expressed [147]. As a result. 

Speirs CT (1976) Tobramycin side effects international results. Scott Med J 21 178-181 Spektorova AI (1961) Antibiotiki 6 226. Cited by Dedney JM (1977) in Immunology of the antibiotics. In Sela (M) ed The antigens, vol IV. Academic Press, New York London Stevens EAM, Joniau M, Verbist L (1973) Preliminary data on immunological experiments with rifamycin conjugates. Scand J Respir Dis (Suppl.) 84 36-39 Sulkowski SR, Haserick JR (1964) Simulated systemic lupus erythematosus from degraded tetracycline. JAMA 189 152-154... 

Tan EM, Rothfeld NF (1978) Systemic lupus erythematosus. In Samter M (ed) Immunological diseases. Little Brown, Boston, pp 1038-1060... 

Hahn BH (1980) Systemic lupus erythematosus. In Parker CW (ed) Chnical immunology. Saunders WB, pp 583-631... 

Immunologic A 32-year-old woman with new-onset systemic lupus erythematosus developed anaphylaxis when she took a 250-mg tablet of mefenamic acid [23 ]. 

Immunologic Although chloroquine has been used successfully in the treatment of systemic lupus erythematosus, its exact mechanism of action is not known. Matrix metalloproteinases (MMPs) may play a role in the immune response and tissue damage that occur in autoimmune skin diseases. The effects of chloroquine for 3 months on serum MMP activities and tissue inhibitors of metalloproteinases (TIMPs) have been studied in 25 patients with SLE and in 25 sex- and age-matched controls [4 ]. Before treatment, MMP activities were significantly much higher in the patients with SLE, as were TIMP concentrations. After chloroquine treatment, the MMP activities fell significantly while TIMP concentrations increased... 

Immunologic The medical records of 10 patients, mean age 35 (26-44) years who developed systemic lupus erythematosus after hepatitis B immunization, have been analysed retrospectively, to determine the prevalence of different manifestations and the time course after immunization [23 ]. Two patients had received one dose, two had received two doses, and six had received three doses. The mean interval between the first dose and the onset of autoimmune symptoms was 56 days. The authors concluded that data from this case-series, and previously docmnented cases, could only demonstrate a temporal relation between hepatitis B immunization and the appearance of systemic lupus erythematosus and not a causative one. 

Holgate ST, Glass DN, Haslam P, et al. Respiratory involvement in systemic lupus erythematosus. A chnical and immunological study. Clin Exp Immunol 1976 24(3) 385-395. 

Immunologic Skin testing of 26 patients clinically diagnosed with immediate (type I) hypersensitivity to infliximab found seven positives (30%) and six of these had infliximab-reactive serum IgE antibo es. One skin test-positive patient had no detectable IgE antibodies to the mAb [155 ]. After multiple infusions with infliximab, a 61-year-old woman with Crohn s disease experienced an acute anaphylactic reaction immediately after the start of an infusion. Although anti-infliximab IgE antibodies were not detected, the concentration of anti-infliximab IgG was high and this remained the case 1 year after the mAb was discontinued. Substitution of adalimumab for infliximab 1 week after the anaphylactic reaction was tolerated until the 12th day when the patient displayed a delayed, type IV hypersensitivity reaction mediated by IgG antibodies specific for adalimumab [ISb ]. In addition to types I and IV hypersensitivities to infliximab, other immune-mediated reactions representing the other hypersensitivity states also occur to infliximab. This is illustrated by a recent report of a case of a 27-year-old woman of infliximab-induced systemic lupus erythematosus [157 ], an autoimmune connective tissue disease which is both a type II and a type III hypersensitivity response. 

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