Conceptualizing immune responsiveness

Maternal known drug allergy and long-term neurological hospitalizations of the offspring

PROBLEM

Drug allergies are increasingly common. Immunological factors, implicated in many neurological diseases, also influence an individual's susceptibility. We sought to ascertain a possible association between maternal drug allergy and long-term neurological-related hospitalizations in the offspring.

METHOD OF STUDY

This is a population-based cohort analysis, comparing the long-term risk of neurological-related hospitalization, involving a predefined set of ICD9 codes as recorded in hospital records, of children born to mothers with and without drug allergies. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Twin pregnancies, fetal malformations, and cases of perinatal mortality were excluded. A Kaplan-Meier survival curve was constructed to compare cumulative neurological hospitalizations. A Cox proportional hazards model was used to control for time to event.

RESULTS

The study included 242 342 patients, 9714 with known drug allergy (4%). Offspring born to mothers with drug allergies had significantly more neurological hospitalizations compared to controls (4.2% vs 3.1%; P ≤ .001; Kaplan-Meier log-rank test P ≤ .001), specifically for psychiatric disorders including eating disorders (0.3% vs 0.2%;P = .002), attention-deficit/hyperactivity disorder (0.124% vs 0.056%; P = .008), emotional disorders (0.8% vs 0.5%; P ≤ .001), and movement disorders (2.3% vs 1.8%; P = .002). While controlling for birth year, gestational age, maternal age, maternal diabetes, hypertensive disorders, and cesarean delivery, using a Cox proportional hazards model, maternal drug allergy was found to be an independent risk factor for neurological hospitalization of the offspring (adjusted HR 1.3, 95% CI 1.19-1.45 P < .001).

CONCLUSION

Being born to a mother with known drug allergy is an independent risk factor for long-term neurological hospitalization of the offspring.

Adverse Immunologically Mediated Oral Mucosal Reactions to Systemic Medication: Lichenoid Tissue Reaction/Interface Dermatitis-Stomatitis, Autoimmune Vesiculobullous Disease, and IgE-Dependent and Immune Complex Reactions

Drug-induced hypersensitivity immune reactions are exaggerated immunoinflammatory responses to allergenic components of the medications that occur in genetically susceptible subjects. The type of hypersensitivity immune response generated, whether antibody mediated or T cell mediated, or an immune complex reaction is determined by multiple factors, including the molecular characteristics of the allergen, the route of administration of the medication, the manner of presentation of the allergen by antigen-presenting cells to naïve T cells, the repertoire of the T cell receptors, and the cytokine profile within the microenvironment. This review deals with the clinical and histopathological aspects of adverse immunologically mediated oral mucosal reactions to systemic medication. We elaborate on diseases showing features of lichenoid tissue reaction/interface dermatitis-stomatitis, autoimmune vesiculobullous oral lesions, and immunoglobulin E- (IgE-) and immune complex-mediated oral reactions to drugs.

The danger theory: 20 years later

The self-non-self theory has dominated immunology since the 1950s. In the 1990s, Matzinger and her colleagues suggested a new, competing theory, called the "danger theory." This theory has provoked mixed acclaim: enthusiasm and criticism. Here we assess the danger theory vis-à-vis recent experimental data on innate immunity, transplantation, cancers and tolerance to foreign entities, and try to elucidate more clearly whether danger is well defined.

Attributing functions to genes and gene products

A major focus of modern biochemical, biophysical and cell biological research is the attribution of function to elements of structure: gene products, genes and higher-order cellular structures. Misunderstandings and controversies can arise in connection with such assignments, in part because of the logical complexity inherent in the relating of structure to function and the failure to distinguish clearly among the different senses in which function can be imputed to elements of structure. I explore distinct ways in which functions are connected to structures and factors that contribute to the context-dependence of such associations so that the multiple senses of function can be made explicit.

Immunogenetics of drug-induced skin blistering disorders. Part I: Perspective

The overall immunopathogenesis relevant to a large series of disorders caused by a drug or its associated hyperimmune condition is discussed based upon the examination of the genetics of severe drug-induced bullous skin problems (sporadic idiosyncratic adverse events, including Stevens-Johnson syndrome and toxic epidermal necrolysis). An overarching pharmacogenetic schema is proposed. Immune cognition and early-effector processes are focused upon and a challenging synthesis around systems evolution is explained by a variety of projective analogies. Etiology, human leukocyte antigen-B, immune stability, dysregulation, pharmacomimicry, viruses and an aggressive ethnically differentiated 'karmic' response are discussed.

Immunogenetics of drug-induced skin blistering disorders. Part II: Synthesis

The overall immunopathogenesis relevant to a large series of disorders caused by a drug or its associated hyperimmune condition is discussed based upon examining the genetics of severe drug-induced bullous skin problems (sporadic idiosyncratic adverse events including Stevens–Johnson syndrome and Toxic epidermal necrolysis). New results from an exemplar study on shared precipitating and perpetuating inner causes with other related disease phenotypes including aphtous stomatitis, Behçets, erythema multiforme, Hashimoto’s thyroiditis, pemphigus, periodic fevers, Sweet’s syndrome and drug-induced multisystem hypersensitivity are presented. A call for a collaborative, wider demographic profiling and deeper immunotyping in suggested future work is made.

In vivo-to-in silico iterations to investigate aeroallergen-host interactions

BACKGROUND

Allergic asthma is a complex process arising out of the interaction between the immune system and aeroallergens. Yet, the relationship between aeroallergen exposure, allergic sensitization and disease remains unclear. This knowledge is essential to gain further insight into the origin and evolution of allergic diseases. The objective of this research is to develop a computational view of the interaction between aeroallergens and the host by investigating the impact of dose and length of aeroallergen exposure on allergic sensitization and allergic disease outcomes, mainly airway inflammation and to a lesser extent lung dysfunction and airway remodeling.

METHODS AND PRINCIPAL FINDINGS

BALB/C mice were exposed intranasally to a range of concentrations of the most pervasive aeroallergen worldwide, house dust mite (HDM), for up to a quarter of their lifespan (20 weeks). Actual biological data delineating the kinetics, nature and extent of responses for local (airway inflammation) and systemic (HDM-specific immunoglobulins) events were obtained. Mathematical equations for each outcome were developed, evaluated, refined through several iterations involving in vivo experimentation, and validated. The models accurately predicted the original biological data and simulated an extensive array of previously unknown responses, eliciting two- and three-dimensional models. Our data demonstrate the non-linearity of the relationship between aeroallergen exposure and either allergic sensitization or airway inflammation, identify thresholds, behaviours and maximal responsiveness for each outcome, and examine inter-variable relationships.

CONCLUSIONS

This research provides a novel way to visualize allergic responses in vivo and establishes a basic experimental platform upon which additional variables and perturbations can be incorporated into the system.

miniTUBA: medical inference by network integration of temporal data using Bayesian analysis

MOTIVATION

Many biomedical and clinical research problems involve discovering causal relationships between observations gathered from temporal events. Dynamic Bayesian networks are a powerful modeling approach to describe causal or apparently causal relationships, and support complex medical inference, such as future response prediction, automated learning, and rational decision making. Although many engines exist for creating Bayesian networks, most require a local installation and significant data manipulation to be practical for a general biologist or clinician. No software pipeline currently exists for interpretation and inference of dynamic Bayesian networks learned from biomedical and clinical data.

RESULTS

miniTUBA is a web-based modeling system that allows clinical and biomedical researchers to perform complex medical/clinical inference and prediction using dynamic Bayesian network analysis with temporal datasets. The software allows users to choose different analysis parameters (e.g. Markov lags and prior topology), and continuously update their data and refine their results. miniTUBA can make temporal predictions to suggest interventions based on an automated learning process pipeline using all data provided. Preliminary tests using synthetic data and laboratory research data indicate that miniTUBA accurately identifies regulatory network structures from temporal data.

AVAILABILITY

miniTUBA is available at http://www.minituba.org.