1
|
McLean-Tooke A, Klinken E. Post-Orgasmic Illness Syndrome Successfully Treated with Omalizumab: A Case Report. J Sex Marital Ther 2023; 50:342-345. [PMID: 38124662 DOI: 10.1080/0092623x.2023.2295256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Post-orgasmic illness syndrome (POIS) is a rare disorder associated with a debilitating symptoms post-ejaculation associated with significant impairment in quality of life. The mechanism of the disease is unclear, but hypersensitivity to semen and/or seminal fluid has been postulated. We present a case of POIS successfully treated with omalizumab suggesting a possible role for this therapy in POIS treatment and management.
Collapse
Affiliation(s)
| | - Elizabeth Klinken
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Australia
| |
Collapse
|
2
|
Shivarev A, Phillips A, Brophy-Williams S, Ford T, Richmond P, Effler P, McLean-Tooke A. Adverse event reports of anaphylaxis after Comirnaty and Vaxzevria COVID-19 vaccinations, Western Australia, 22 February to 30 June 2021. Intern Med J 2023; 53:275-279. [PMID: 36585764 PMCID: PMC9880615 DOI: 10.1111/imj.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/02/2022] [Indexed: 01/01/2023]
Abstract
Within the first 4 months of the Western Australian COVID-19 immunisation programme, 49 suspected anaphylaxis cases were reported to the vaccine safety surveillance system. Twelve reports met Brighton Collaboration case definition, corresponding to rates of 15.9 and 17.7 per million doses of Vaxzevria and Comirnaty administered respectively.
Collapse
Affiliation(s)
- Alexander Shivarev
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Metropolitan Communicable Disease Control, North Metropolitan Health Service, Perth, Western Australia, Australia
| | - Anastasia Phillips
- Metropolitan Communicable Disease Control, North Metropolitan Health Service, Perth, Western Australia, Australia
| | - Sam Brophy-Williams
- Western Australian Vaccine Safety Surveillance and Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Tim Ford
- Western Australian Vaccine Safety Surveillance and Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia.,Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter Richmond
- Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of General Paediatrics and Immunology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Paul Effler
- Department of Health, Communicable Disease Control Directorate, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| |
Collapse
|
3
|
McLean-Tooke A, Lucas M, French M. Autoimmunity elicited by the chemokine response to adenovirus vector vaccines may underlie vaccine-induced immune thrombotic thrombocytopaenia: a hypothesis. Clin Transl Immunology 2021; 10:e1349. [PMID: 34691454 PMCID: PMC8517088 DOI: 10.1002/cti2.1349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- Andrew McLean-Tooke
- Department of Clinical Immunology Sir Charles Gairdner Hospital Perth WA Australia.,Department of Laboratory Immunology PathWest QEII Medical Centre Perth WA Australia
| | - Michaela Lucas
- Department of Clinical Immunology Sir Charles Gairdner Hospital Perth WA Australia.,Department of Laboratory Immunology PathWest QEII Medical Centre Perth WA Australia.,Medical School University of Western Australia Perth WA Australia
| | - Martyn French
- Division of Immunology PathWest Laboratory Medicine Perth WA Australia.,School of Biomedical Sciences University of Western Australia Perth WA Australia
| |
Collapse
|
4
|
Moseley N, King J, Van Dort B, Williams S, Rodriguez-Casero V, Ramachandran S, Choo S, Cole T, McLean-Tooke A. Anti-voltage-Gated Potassium Channel (VGKC) Antibodies and Acquired Neuromyotonia in Patients with Immune Dysregulation, Polyendocrinopathy, Enteropathy X-Lined (IPEX) Syndrome. J Clin Immunol 2021; 41:1972-1974. [PMID: 34478044 DOI: 10.1007/s10875-021-01128-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/24/2021] [Indexed: 11/26/2022]
MESH Headings
- Adolescent
- Autoantibodies/blood
- Child
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/congenital
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/therapy
- Diarrhea/blood
- Diarrhea/genetics
- Diarrhea/immunology
- Diarrhea/therapy
- Forkhead Transcription Factors/genetics
- Genetic Diseases, X-Linked/blood
- Genetic Diseases, X-Linked/genetics
- Genetic Diseases, X-Linked/immunology
- Genetic Diseases, X-Linked/therapy
- Hematopoietic Stem Cell Transplantation
- Humans
- Immune System Diseases/blood
- Immune System Diseases/congenital
- Immune System Diseases/genetics
- Immune System Diseases/immunology
- Immune System Diseases/therapy
- Infant, Newborn
- Isaacs Syndrome/blood
- Isaacs Syndrome/genetics
- Isaacs Syndrome/immunology
- Isaacs Syndrome/therapy
- Male
- Mutation
- Potassium Channels, Voltage-Gated/immunology
Collapse
Affiliation(s)
- Natasha Moseley
- Department of Paediatric Immunology, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jovanka King
- Department of Paediatric Immunology, Perth Children's Hospital, Nedlands, WA, Australia
- Department of Immunology, PP Block, PathWest, QEII, Nedlands, WA, 6008, Australia
| | - Ben Van Dort
- Department of Paediatric Immunology, Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC, Australia
| | - Simon Williams
- Department of Neurology, Perth Children's Hospital, Nedlands, WA, Australia
| | | | - Shanti Ramachandran
- Department of Oncology, Haematology, Blood and Marrow Transplantation, Perth Children's Hospital, Nedlands, WA, Australia
- School of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Sharon Choo
- Department of Paediatric Immunology, Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC, Australia
- Immunology Laboratory, The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Theresa Cole
- Department of Paediatric Immunology, Children's Cancer Centre, The Royal Children's Hospital Melbourne, VIC, Australia
| | - Andrew McLean-Tooke
- Department of Paediatric Immunology, Perth Children's Hospital, Nedlands, WA, Australia.
- Department of Immunology, PP Block, PathWest, QEII, Nedlands, WA, 6008, Australia.
| |
Collapse
|
5
|
Ryan J, Tieu J, Bose B, Francis R, Gingold M, Goh L, Gray J, Hill CL, Hissaria P, Jahan S, Langguth D, Li J, McLean-Tooke A, Peh CA, Rahman M, Sammel T, Stamp LK, Street M, Swaminathan S, Wong NL, Kitching R. Formation of the Australia and New Zealand Vasculitis Society to improve the care of patients with Vasculitis in Australian and New Zealand. Intern Med J 2021; 50:781-783. [PMID: 32656978 DOI: 10.1111/imj.14898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Jessica Ryan
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Monash Health, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Joanna Tieu
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Rheumatology Unit, Lyell McEwin Hospital, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Bhadran Bose
- Department of Nephrology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Ross Francis
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Gingold
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Rheumatology, Monash Health, Melbourne, Victoria, Australia
| | - Liang Goh
- Renal Department, Auckland City Hospital, Auckland, New Zealand
| | - James Gray
- Department of Rheumatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Department of Medicine, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Catherine L Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Sadia Jahan
- Department of Nephrology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Daman Langguth
- Immunology Department, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Jennifer Li
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Andrew McLean-Tooke
- Department of Immunology, Sir Charles Gairdner Hospital, QEII Medical Centre, Perth, Western Australia, Australia
| | - Chen A Peh
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.,Department of Renal Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mukhlesur Rahman
- Department of Medicine, Caboolture Hospital, Moreton Bay Region, Queensland, Australia
| | - Tony Sammel
- Rheumatology Department, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinic School, University of New South Wales, Sydney, New South Wales, Australia
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Mark Street
- Consumer Representative, Brisbane, Queensland, Australia
| | - Sanjay Swaminathan
- Department of Clinical Immunology, Westmead and Blacktown Hospitals, Sydney, New South Wales, Australia.,Department of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Nikki L Wong
- Department of Nephrology, Nepean Hospital, Sydney, New South Wales, Australia
| | - Richard Kitching
- Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology, Monash Health, Monash Medical Centre, Melbourne, Victoria, Australia
| |
Collapse
|
6
|
Thompson G, McLean-Tooke A, Lucas M. Cross With Caution: Antibiotic Cross-Reactivity and Co-Reactivity Patterns in Severe Cutaneous Adverse Reactions. Front Immunol 2021; 12:601954. [PMID: 33717082 PMCID: PMC7947317 DOI: 10.3389/fimmu.2021.601954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022] Open
Abstract
Current understanding of cross-reactivity in severe cutaneous adverse reactions to beta-lactam antibiotics is limited, thereby making recommendations for future prescribing difficult. The underlying immunopathogenesis of these reactions is not completely understood but involves interactions between small molecule drugs, T cells and HLA molecules. Historically, these reactions were considered to be specific to the inciting antibiotic and therefore likely to have minimal cross-reactivity. We assessed patients presenting with non-SJS/TEN severe cutaneous adverse reactions to a tertiary hospital drug allergy clinic. In our case series cross-reactivity or co-reactivity commonly occurred among the beta-lactam antibiotic class, however further research is required to investigate and understand patterns of cross-reactivity. Based on our experience we provide clinicians with a practical algorithm for testing for cross-reactivity in non-SJS/TEN severe cutaneous adverse reactions.
Collapse
Affiliation(s)
- Grace Thompson
- Queen Elizabeth II Medical Centre, Department of Clinical Immunology, Sir Charles Gairdner Hospital, Pathwest, Nedlands, WA, Australia
| | - Andrew McLean-Tooke
- Queen Elizabeth II Medical Centre, Department of Clinical Immunology, Sir Charles Gairdner Hospital, Pathwest, Nedlands, WA, Australia
| | - Michaela Lucas
- Queen Elizabeth II Medical Centre, Department of Clinical Immunology, Sir Charles Gairdner Hospital, Pathwest, Nedlands, WA, Australia.,Medical School, University of Western Australia, Nedlands, WA, Australia
| |
Collapse
|
7
|
King JR, Grover Z, Irani N, McLean-Tooke A. Vedolizumab is safe and effective in the treatment of X-linked agammaglobulinemia–associated inflammatory bowel disease. The Journal of Allergy and Clinical Immunology: In Practice 2021; 9:1006-1007. [DOI: 10.1016/j.jaip.2020.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
|
8
|
Hoo T, Lim EM, John M, D'Orsogna L, McLean-Tooke A. Calculated globulin as a screening tool for hypogammaglobulinaemia or paraproteins in hospitalized patients. Ann Clin Biochem 2021; 58:236-243. [PMID: 33430600 DOI: 10.1177/0004563221989737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Calculated globulin fraction is derived from the liver function tests by subtracting albumin from the total protein. Since immunoglobulins comprise the largest component of the serum globulin concentration, increased or decreased calculated globulins and may identify patients with hypogammaglobulinaemia or hypergammaglobulinaemia, respectively. METHODS A retrospective study of laboratory data over 2.5 years from inpatients at three tertiary hospitals was performed. Patients with paired calculated globulins and immunoglobulin results were identified and clinical details reviewed. The results of serum electrophoresis testing were also assessed where available. RESULTS A total of 4035 patients had paired laboratory data available. A calculated globulin ≤20 g/L (<2nd percentile) had a low sensitivity (5.8%) but good positive predictive value (82.5%) for hypogammaglobulinaemia (IgG ≤5.7 g/L), with a positive predictive value of 37.5% for severe hypogammaglobulinaemia (IgG ≤3 g/L). Paraproteins were identified in 123/291 (42.3%) of patients with increased calculated globulins (≥42 g/L) who also had a serum electrophoresis performed. Significantly elevated calculated globulin ≥50 g/L (>4th percentile) were seen in patients with either liver disease (37%), haematological malignancy (36%), autoimmune disease (13%) or infections (9%). CONCLUSIONS Calculated globulin is an inexpensive and easily available test that assists in the identification of hypogammaglobulinaemia or hypergammaglobulinaemia which may prompt further investigation and reduce diagnostic delays.
Collapse
Affiliation(s)
- Teng Hoo
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ee Mun Lim
- Department of Biochemistry, PathWest QEII Medical Centre, Perth, Australia
| | - Mina John
- Department of Laboratory Immunology, PathWest Fiona Stanley Hospital, Perth, Australia.,Department of Immunology, Royal Perth Hospital, Perth, Australia
| | - Lloyd D'Orsogna
- Department of Laboratory Immunology, PathWest Fiona Stanley Hospital, Perth, Australia.,School of Medicine, The University of Western Australia, Perth, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Australia.,Department of Laboratory Immunology, PathWest QEII Medical Centre, Perth, Australia
| |
Collapse
|
9
|
Richards S, Gennery AR, Davies EG, Wong M, Shaw PJ, Peake J, Fraser C, Gray P, Brothers S, Sinclair J, Prestidge T, Preece K, Quinn P, Ramachandran S, Loh R, McLean-Tooke A, Mitchell R, Cole T. Diagnosis and management of severe combined immunodeficiency in Australia and New Zealand. J Paediatr Child Health 2020; 56:1508-1513. [PMID: 33099818 DOI: 10.1111/jpc.15158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/06/2023]
Abstract
This consensus document outlines the recommendations from the Australasian Society of Clinical Immunology and Allergy Transplantation and Primary Immunodeficiency group for the diagnosis and management of patients with severe combined immunodeficiency. It also provides a proposed framework for the early investigation, management and supportive care prior to haematopoietic stem cell transplantation.
Collapse
Affiliation(s)
- Stephanie Richards
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andrew R Gennery
- Paediatric Immunology and Haematopoietic Stem Cell Transplantation, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom.,Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - E Graham Davies
- Department of Immunology, Great Ormond Street Hospital, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Melanie Wong
- Department of Allergy and Immunology, Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Peter J Shaw
- Bone Marrow Transplant Unit, Children's Hospital Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jane Peake
- Department of Allergy and Immunology, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Discipline of Paediatrics and Child Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Chris Fraser
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Paul Gray
- Department of Immunology, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Shannon Brothers
- Department of Immunology and Allergy, Starship Children's Hospital, Auckland, New Zealand.,Newborn Metabolic Screening, Specialist Chemical Pathology Department, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Jan Sinclair
- Department of Immunology and Allergy, Starship Children's Hospital, Auckland, New Zealand
| | - Tim Prestidge
- Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand
| | - Kahn Preece
- Allergy and Immunology Department, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Patrick Quinn
- Department of Allergy and Clinical Immunology, Women and Children's Hospital, Adelaide, South Australia, Australia.,Discipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Shanti Ramachandran
- Department of Paediatric and Adolescent Oncology and Haematology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Immunology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Richard Mitchell
- School of Women and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.,Kids Cancer Centre, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Theresa Cole
- Department of Allergy and Immunology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | | |
Collapse
|
10
|
Wong B, Tan E, McLean-Tooke A. Pulmonary granulomas in a patient with positive ANCA and history of tuberculosis: case report. BMC Pulm Med 2020; 20:219. [PMID: 32795275 PMCID: PMC7427886 DOI: 10.1186/s12890-020-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Granulomatous polyangiitis (GPA) is a rare multisystem autoimmune disease of unknown aetiology that is pathologically characterised by necrotising vasculitis, tissue necrosis and granulomatous inflammation, typically in the presence of anti-neutrophil cytoplasmic antibodies (ANCA). However infectious diseases may induce high titre ANCA and mimic vasculitis. Tuberculosis may share many clinical features with GPA including fever, arthralgia, granulomatous inflammation and pulmonary lesions and patients. CASE PRESENTATION A 39 year old patient was admitted with ocular irritation and redness, arthralgia and multiple new pulmonary lesions. The past medical history was significant for two episodes of tuberculosis previously requiring prolonged treatment. ANCA antibodies were positive and CT showed multiple pulmonary lesions including cavitatory lesions. After extensive investigation, the patient was treated for GPA with high dose immune suppression with good clinical response. CONCLUSIONS Here we review the diagnostic considerations between differentiating GPA and tuberculosis in patients from endemic regions. It is recommended that biopsies of lung lesions, sputum microscopy and multidisciplinary team input are sought as part of the workup when these two differentials are being considered.
Collapse
Affiliation(s)
- B Wong
- Dept of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia.
| | - E Tan
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| | - A McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Nedlands, 6009, Australia
| |
Collapse
|
11
|
Thompson G, Grover Z, Loh R, Mews C, Ravikumara M, Jevon G, D'Orsogna L, McLean-Tooke A. Assessment of European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines in an Australian paediatric population. Pathology 2020; 52:568-575. [PMID: 32586687 DOI: 10.1016/j.pathol.2020.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
Coeliac disease (CD) diagnosis is based on clinical assessment, detection of specific autoantibodies and histological examination of small intestinal biopsies. The European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) guidelines have recently been updated and recommend CD may be diagnosed without a biopsy or HLA typing in symptomatic patients with high titre IgA tissue transglutaminase antibodies (aTTG) and positive endomysial antibodies (EMA). However, the need for EMA in patients with high level aTTG has been questioned. We aimed to determine the diagnostic benefit of HLA typing, EMA and IgG antibodies to deamidated gliadin (DGP) in children with high level aTTG. We prospectively evaluated children presenting for assessment of possible CD. All patients underwent small bowel biopsy, serological testing and HLA typing. Results were analysed and correlated with histopathological diagnosis. A total of 209 children were assessed; 61.5% were found to have CD and 29% could have avoided biopsy as per 2020 ESPGHAN guidelines. Titres of aTTG ≥60 U/mL or DGP ≥28 U/mL gave 100% specificity and 100% positive predictive value (PPV) for CD. HLA typing and EMA did not improve the PPV of patients with aTTG ≥60 U/mL, but addition of DGP ≥28 U/mL improved diagnostic sensitivity whilst retaining 100% specificity. Addition of HLA and EMA testing in patients with high titre aTTG antibodies does not improve diagnostic performance and may possibly be omitted from the serological workup in these patients. Our data support combining aTTG and DGP testing and optimising cut-offs to maximise specificity as an alternative biopsy-free diagnostic approach.
Collapse
Affiliation(s)
- Grace Thompson
- Department of Clinical Immunology, PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Zubin Grover
- Department of Gastroenterology, Perth Children's Hospital, Perth, WA, Australia
| | - Richard Loh
- Department of Clinical Immunology, PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Catherine Mews
- Department of Gastroenterology, Perth Children's Hospital, Perth, WA, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, WA, Australia
| | - Gareth Jevon
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Lloyd D'Orsogna
- Department of Clinical Immunology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; Department of Immunology, Perth Children's Hospital, Perth, WA, Australia
| |
Collapse
|
12
|
Stevenson B, Bundell C, Mulrennan S, McLean-Tooke A, Murray R, Brusch A. The significance of anti-granulocyte-macrophage colony-stimulating factor antibodies in cryptococcal infection: case series and review of antibody testing. Intern Med J 2020; 49:1446-1450. [PMID: 31713345 DOI: 10.1111/imj.14637] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 06/17/2019] [Accepted: 08/26/2019] [Indexed: 11/29/2022]
Abstract
We report two cases of cryptococcosis, associated with anti-granulocyte-macrophage colony-stimulating factor antibodies. We review this recently identified acquired form of autoimmune immune deficiency and discuss the potential applications of granulocyte-macrophage colony-stimulating factor antibody testing by enzyme-linked immunosorbent assay.
Collapse
Affiliation(s)
- Brittany Stevenson
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of Immunology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Department of Immunology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia.,School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,UWA Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of Immunology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Ronan Murray
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia.,Department of Infectious Diseases, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Anna Brusch
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of Immunology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| |
Collapse
|
13
|
Lam D, Jansen S, Tibballs J, McLean-Tooke A. Fibromuscular dysplasia presenting with a deep vein thrombosis. BMJ Case Rep 2020; 13:13/2/e233315. [PMID: 32094235 DOI: 10.1136/bcr-2019-233315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 41-year-old male patient presented with isolated right lower limb swelling. An ultrasound scan showed right external iliac and femoral vein deep vein thrombosis due to extrinsic compression by an aneurysm of the right common iliac artery. Investigations including imaging and a tissue biopsy of right and left femoral arteries confirmed a rare clinical presentation of fibromuscular dysplasia involving iliac, coeliac, renal and pulmonary vessels. The common iliac artery aneurysm was successfully treated with endovascular repair. Six months later, he developed coronary artery involvement with spontaneous dissection of left anterior descending artery diagnosed on coronary angiogram which was managed conservatively. At 6-year follow-up, he remains clinically asymptomatic and continues with regular surveillance imaging. Iliac arterial fibromuscular dysplasia is uncommon and clinical presentation with a complication such as a deep vein thrombosis is atypical.
Collapse
Affiliation(s)
- Danielle Lam
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Jonathan Tibballs
- Department of Interventional Radiology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia .,Department of Immunology, PathWest Laboratory Medicine Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
14
|
Kailaivasan TH, Timbrell VL, Solley G, Smith WB, McLean-Tooke A, van Nunen S, Smith P, Upham JW, Langguth D, Davies JM. Biogeographical variation in specific IgE recognition of temperate and subtropical grass pollen allergens in allergic rhinitis patients. Clin Transl Immunology 2020; 9:e01103. [PMID: 32025301 PMCID: PMC6997006 DOI: 10.1002/cti2.1103] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Globally, grass pollens (GP) are major aeroallergen triggers of allergic rhinitis (AR) and asthma. However, patterns of allergic sensitisation to pollen of temperate (Pooideae: Lolium perenne) and subtropical (Chloridoideae: Cynodon dactylon and Panicoideae: Paspalum notatum) subfamilies in diverse climates remain unclear. This study aims to evaluate the level of allergic sensitisation and IgE specificity for major GP allergens representing the three subfamilies in biogeographically distinct regions. Methods Participants (GP‐allergic with AR, 330; non‐atopic, 29; other allergies, 54) were recruited in subtropical: Queensland, and temperate: New South Wales, Western and South Australia, regions. Clinical history, skin prick test (SPT), total and specific IgE to GP and purified allergens (ImmunoCAP) were evaluated. Cross‐inhibition of sIgE with Pas n 1, Cyn d 1 and Lol p 1 by GP extracts was investigated. Results Queensland participants showed higher sensitisation to P. notatum and C. dactylon than L. perenne GP. sIgE was higher to Pas n 1 and Cyn d 1, and sIgE to Pas n 1 and Cyn d 1 was inhibited more by Panicoideae and Chloridoideae, respectively, than Pooideae GP. Conversely, participants from temperate regions showed highest sensitisation levels to L. perenne GP and Lol p 1, and sIgE to Lol p 1 was inhibited more by Pooideae than other GP. Conclusion Levels and patterns of sensitisation to subtropical and temperate GP in AR patients depended on biogeography. Knowledge of the specificity of sensitisation to local allergens is important for optimal diagnosis and choice of allergen‐specific immunotherapy to maximise benefit.
Collapse
Affiliation(s)
- Thina H Kailaivasan
- School of Biomedical Sciences Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane QLD Australia
| | - Victoria L Timbrell
- School of Biomedical Sciences Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane QLD Australia
| | | | | | | | - Sheryl van Nunen
- Royal North Shore Hospital and The University of Sydney Sydney NSW Australia
| | - Peter Smith
- Queensland Allergy Services Gold Coast QLD Australia
| | - John W Upham
- The University of Queensland and The Princess Alexandra Hospital Brisbane QLD Australia
| | | | - Janet M Davies
- School of Biomedical Sciences Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane QLD Australia.,Metro North Hospital and Health Service Herston QLD Australia
| |
Collapse
|
15
|
Horgan L, McLean-Tooke A, O’Sullivan M. Making the diagnosis of ALPS; learning from an error. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
16
|
Klinken EM, Gray PE, Pillay B, Worley L, Edwards ESJ, Payne K, Bennetts B, Hung D, Wood BA, Chan JJ, Marshall GM, Mitchell R, Uzel G, Ma CS, Tangye SG, McLean-Tooke A. Diversity of XMEN Disease: Description of 2 Novel Variants and Analysis of the Lymphocyte Phenotype. J Clin Immunol 2019; 40:299-309. [DOI: 10.1007/s10875-019-00732-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/04/2019] [Indexed: 01/22/2023]
|
17
|
McLean-Tooke A, Moore I, Lake F. Idiopathic and immune-related pulmonary fibrosis: diagnostic and therapeutic challenges. Clin Transl Immunology 2019; 8:e1086. [PMID: 31709050 PMCID: PMC6831929 DOI: 10.1002/cti2.1086] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/29/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Interstitial lung disease (ILD) encompasses a large group of pulmonary conditions sharing common clinical, radiological and histopathological features as a consequence of fibrosis of the lung interstitium. The majority of ILDs are idiopathic in nature with possible genetic predisposition, but is also well recognised as a complication of connective tissue disease or with certain environmental, occupational or drug exposures. In recent years, a concerted international effort has been made to standardise the diagnostic criteria in ILD subtypes, formalise multidisciplinary pathways and standardise treatment recommendations. In this review, we discuss some of the current challenges around ILD diagnostics, the role of serological testing, especially, in light of the new classification of Interstitial Pneumonia with Autoimmune Features (IPAF) and discuss the evidence for therapies targeted at idiopathic and immune-related pulmonary fibrosis.
Collapse
Affiliation(s)
- Andrew McLean-Tooke
- Department of Clinical Immunology Sir Charles Gairdner Hospital Perth WA Australia.,Department of Laboratory Immunology PathWest QEII Medical Centre Perth WA Australia
| | - Irene Moore
- Department of Respiratory Medicine Fiona Stanley Hospital Perth WA Australia
| | - Fiona Lake
- Department of Respiratory Medicine Sir Charles Gairdner Hospital Perth WA Australia
| |
Collapse
|
18
|
Horgan L, Mulrennan S, D'Orsogna L, McLean-Tooke A. Tracheobronchitis in ulcerative colitis: a case report of therapeutic response with infliximab and review of the literature. BMC Gastroenterol 2019; 19:171. [PMID: 31675916 PMCID: PMC6823962 DOI: 10.1186/s12876-019-1091-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background The extra-intestinal manifestation of tracheobronchitis is a rare complication of ulcerative colitis (UC). Here, we present a case of UC-related tracheobronchitis wherein the positive clinical effects of infliximab are demonstrated. Case presentation We report the case of a 39-year old woman who presented with a chronic productive cough on a distant background of surgically managed ulcerative colitis (UC). Our patient failed to achieve a satisfactory clinical improvement despite treatment with high dose inhaled corticosteroids, oral corticosteroids and azathioprine. Infliximab therapy was commenced and was demonstrated to achieve macroscopic and symptomatic remission of disease. Conclusions We present the first case report documenting the benefits of infliximab in UC-related tracheobronchitis.
Collapse
Affiliation(s)
- Lisa Horgan
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, 6009, Australia
| | - Lloyd D'Orsogna
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, 6009, Australia.,Department of Immunology, Fiona Stanley Hospital, Perth, Australia
| | - Andrew McLean-Tooke
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.,Pathwest, QEII, Perth, Nedlands, Australia
| |
Collapse
|
19
|
Joshi KK, Haynes A, Davis EA, D'Orsogna L, McLean-Tooke A. Role of HLA-DQ typing and anti-tissue transglutaminase antibody titers in diagnosing celiac disease without duodenal biopsy in type 1 diabetes: A study of the population-based pediatric type 1 diabetes cohort of Western Australia. Pediatr Diabetes 2019; 20:567-573. [PMID: 30985044 DOI: 10.1111/pedi.12857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/14/2022] Open
Abstract
AIM The primary aim of the present study was to determine if it is cost effective to use human leukocyte antigen (HLA) typing as a first-line screening test for celiac disease (CD) in children with type 1 diabetes (T1D), as recommended by the European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). The second aim was to investigate whether anti-tissue transglutaminase IgA (anti-tTGA) antibodies can be used to diagnose CD without the need for a confirmatory duodenal biopsy in T1D. METHODS Data for all T1D patients aged <18 years, who attended the diabetes clinics in Western Australia up to June 2017, were extracted from the Western Australian Children's Diabetes Database (WACDD) and analyzed for their demographic data and CD permissive HLA alleles (DQ2, DQ8, and DQ7). For T1D patients already diagnosed with CD, the mode of diagnosis of CD, anti-tTGA titers, and CD permissive HLA alleles were analyzed. RESULTS Of the 936 eligible T1D patients identified, HLA-DQ typing was available for 551 (59%). Of these 551 patients, 504 (91.2%) were positive for celiac permissive HLA alleles. Eight percent (n = 75) of the T1D patients had a co-diagnosis of CD. High anti-tTGA titers were observed in those who were diagnosed with a positive duodenal biopsy. CONCLUSION HLA-DQ typing is not cost effective as a first-line screening test for CD in T1D patients because of over-representation of CD permissive HLA alleles in this group. Anti-tTGA titers may be useful in diagnosing CD in T1D without duodenal biopsy, as high levels were found to be strongly predictive of CD.
Collapse
Affiliation(s)
- Kiranjit K Joshi
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, WA, Australia
| | - Aveni Haynes
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, WA, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
| | - Lloyd D'Orsogna
- Department of Clinical Immunology and PathWest, Fiona Stanley Hospital, Murdoch, WA, Australia.,School of Biomedical Science, University of Western Australia, Perth, WA, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Department of Laboratory Immunology, PathWest QEII Medical Centre, Perth, WA, Australia
| |
Collapse
|
20
|
McLean-Tooke A, Phatouros CC, Chidlow G, Smith DW, Silbert P. Granule Cell Neuronopathy in a Patient with Common Variable Immunodeficiency. J Clin Immunol 2019; 39:267-269. [PMID: 30993493 DOI: 10.1007/s10875-019-00624-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 04/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew McLean-Tooke
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
- Department of Laboratory Immunology, PathWest QEII Medical Centre, Perth, WA, Australia.
| | - Constantine Chris Phatouros
- Neurological Intervention & Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Glenys Chidlow
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, WA, Australia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine WA, Perth, WA, Australia
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Peter Silbert
- School of Medicine, University of Western Australia, Perth, WA, Australia
| |
Collapse
|
21
|
Schauer A, Wood BA, Tan E, Tai A, McLean-Tooke A, Crawford J, Harvey NT. Multiple skin lesions on a background of hypergammaglobulinaemia. Clin Exp Dermatol 2018; 44:787-790. [PMID: 30474260 DOI: 10.1111/ced.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A Schauer
- Princess Margaret Hospital, Perth, WA, Australia
| | - B A Wood
- Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, WA, Australia.,Division of Pathology and Laboratory Medicine, Medical School, University of WA, Perth, WA, Australia
| | - E Tan
- Department of Dermatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - A Tai
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - A McLean-Tooke
- Department of Immunology, PathWest, QEII Medical Centre, Perth, WA, Australia
| | - J Crawford
- Department ofHaematology, PathWest, QEII Medical Centre, Perth, WA, Australia
| | - N T Harvey
- Dermatopathology Group, Department of Anatomical Pathology, PathWest, Perth, WA, Australia.,Division of Pathology and Laboratory Medicine, Medical School, University of WA, Perth, WA, Australia
| |
Collapse
|
22
|
Fabis-Pedrini MJ, Bundell C, Wee CK, Lucas M, McLean-Tooke A, Mastaglia FL, Carroll WM, Kermode AG. Prevalence of anti-aquaporin 4 antibody in a diagnostic cohort of patients being investigated for possible neuromyelitis optica spectrum disorder in Western Australia. J Neuroimmunol 2018; 324:76-80. [PMID: 30248527 DOI: 10.1016/j.jneuroim.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the prevalence of anti-AQP4 antibody in serum and CSF samples from patients being investigated for possible neuromyelitis optica spectrum disorder (NMOSD) referred to the PathWest State reference laboratory using a sensitive cell-based assay (CBA). BACKGROUND NMOSD is an inflammatory CNS disease distinct from MS, which is relatively rare in Western countries. A proportion of patients with NMOSD have detectable serum IgG antibodies that target the water channel aquaporin-4 (AQP4-IgG), but the frequency varies in different populations studied and according to the assay method employed. METHODS Sera or CSF from a diagnostic cohort of 196 consecutive patients with possible NMOSD which had previously been screened by indirect immunofluorescence (IIF) on primate cerebellum were re-tested for AQP4-IgG reactivity to the M1 and M23 isoforms of AQP4 using a commercial CBA. A control group of 205 patients with definite MS was also included in the study. RESULTS Of the 196 patients, only 5 sera were AQP4-IgG positive, representing 2.6% of patients in the diagnostic cohort. All 5 AQP4-IgG positive patients fulfilled the 2015 revised diagnostic criteria for NMOSD and were females of varied ethnic origins, 4 of whom had longitudinally extensive transverse myelitis. The CBA confirmed AQP4-IgG positivity in the four patients previously reported as positive by IIF, and an additional patient with NMOSD who had previously been diagnosed as MS was also identified. None of the 205 MS sera were AQP4-IgG positive. CONCLUSIONS Our study confirms the utility and greater reliability of the M1/M23 CBA for detecting AQP4-IgG in patients with possible NMOSD, and indicates a prevalence of seropositive NMOSD in the Western Australian population similar to that in other Western populations.
Collapse
Affiliation(s)
- Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Chee-Keong Wee
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Michaela Lucas
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, School of Pathology and Laboratory Medicine, UWA, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; Department of Immunology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Department of Immunology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Frank L Mastaglia
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Department of Neurology & Clinical Neurophysiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; Department of Neurology & Clinical Neurophysiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
| |
Collapse
|
23
|
Triplett J, Hee G, McLean-Tooke A, Lucas M. Long-term control of laryngeal plasma cell mucositis with systemic immunosuppression. BMJ Case Rep 2018; 2018:bcr-2017-221333. [PMID: 29930164 DOI: 10.1136/bcr-2017-221333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Plasma cell mucositis (PCM) is a rare non-neoplastic plasma cell proliferative disorder of the mucous membranes, which typically presents as soft tissue lesions involving oral, upper airway or genital mucosa. Laryngeal involvement resulting in stridor has been reported in four other cases previously, with three requiring tracheostomy. We present a case of supraglottic stenosis in a 53-year-old woman presenting with dysphonia and stridor, requiring surgical resection on three occasions accompanied by tracheostomy on two occasions; biopsy was consistent with PCM. Due to relapsing disease activity, high-dose prednisolone and mycophenolate mofetil were commenced with prednisolone eventually being ceased. After 2 years of mycophenolate mofetil therapy, the patient's disease has been controlled without need for further surgical intervention. This is the first reported case of prolonged symptomatic improvement with the use of systemic immunosuppressive therapy with mycophenolate mofetil in PCM.
Collapse
Affiliation(s)
- James Triplett
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Geoffrey Hee
- Department of Otolaryngology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Michaela Lucas
- Department of Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Faculty of Medicine, University of Western Australia, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| |
Collapse
|
24
|
Ali SB, Jeelall Y, Pennell CE, Hart R, McLean-Tooke A, Lucas M. The role of immunological testing and intervention in reproductive medicine: A fertile collaboration? Am J Reprod Immunol 2017; 79. [DOI: 10.1111/aji.12784] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/25/2017] [Indexed: 12/13/2022] Open
Affiliation(s)
- Syed B. Ali
- Department of Clinical Immunology; Sir Charles Gairdner Hospital; Perth WA Australia
| | - Yogesh Jeelall
- School of Medicine and Pharmacology; University of Western Australia; Perth WA Australia
- Harry Perkins Institute of Medical Research; Perth WA Australia
| | - Craig E. Pennell
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
- The Women and Infants Research Foundation; Perth WA Australia
| | - Roger Hart
- School of Women's and Infants’ Health; The University of Western Australia; Perth WA Australia
- Fertility Specialists of Western; Bethesda Hospital; Claremont WA Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology; Sir Charles Gairdner Hospital; Perth WA Australia
- Pathwest Laboratory Medicine; Queen Elizabeth II Medical Centre; Perth WA Australia
| | - Michaela Lucas
- Department of Clinical Immunology; Sir Charles Gairdner Hospital; Perth WA Australia
- Pathwest Laboratory Medicine; Queen Elizabeth II Medical Centre; Perth WA Australia
- School of Medicine and Pharmacology; School of Pathology and Laboratory Medicine; University of Western Australia; Perth WA Australia
- Institute for Immunology and Infectious Diseases; Murdoch University; Perth WA Australia
| |
Collapse
|
25
|
Benwell N, McLean-Tooke A. P87: USE OF RITUXIMAB TO TREAT MOOREN’S ULCER. Intern Med J 2017. [DOI: 10.1111/imj.87_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Benwell
- Sir Charles Gairdner Hospital; Perth Australia
| | | |
Collapse
|
26
|
Knezevic B, McLean-Tooke A. CGR 9: OUT ON A LIMB: AN UNUSUAL CASE OF VASCULITIS. Intern Med J 2017. [DOI: 10.1111/imj.9_13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- B Knezevic
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
| | - A McLean-Tooke
- Department of Immunology, Sir Charles Gairdner Hospital; Perth Australia
| |
Collapse
|
27
|
Knezevic B, Sprigg D, Seet J, Trevenen M, Trubiano J, Smith W, Jeelall Y, Vale S, Loh R, McLean-Tooke A, Lucas M. The revolving door: antibiotic allergy labelling in a tertiary care centre. Intern Med J 2017; 46:1276-1283. [PMID: 27530619 DOI: 10.1111/imj.13223] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients frequently report antibiotic allergies; however, only 10% of labelled patients have a true allergy. AIM We investigated the documentation of antibiotic 'allergy' labels (AAL) and the effect of labelling on clinical outcomes, in a West Australian adult tertiary hospital. METHODS Retrospective cross-sectional analysis of patients captured in the 2013 and 2014 National Antimicrobial Prescribing Surveys was carried out. Data were collected on documented antibiotic adverse drug reactions, antibiotic cost, prescribing appropriateness, prevalence of multi-drug resistant organisms, length of stay, intensive care admission and readmissions. RESULTS Of the 687 patients surveyed, 278 (40%) were aged 70 or above, 365 (53%) were male and 279 (41%) were prescribed antibiotics. AAL were recorded in 122 (18%) patients and the majority were penicillin labels (n = 87; 71%). Details of AAL were documented for 80 of 141 (57%) individual allergy labels, with 61 describing allergic symptoms. Patients with beta-lactam allergy labels received fewer penicillins (P = 0.0002) and more aminoglycosides (P = 0.043) and metronidazole (P = 0.021) than patients without beta-lactam labels. Five patients received an antibiotic that was contraindicated according to their allergy status. Patients with AAL had significantly more hospital readmissions within 4 weeks (P = 0.001) and 6 months (P = 0.025) of discharge, compared with unlabelled patients. The majority (81%) of readmitted labelled patients had major infections. CONCLUSIONS AAL are common, but poorly documented in hospital records. Patients with AAL are significantly more likely to require alternative antibiotics and hospital readmissions. There may be a role for antibiotic allergy delabelling to mitigate the clinical and economic burdens for patients with invalid allergy labels.
Collapse
Affiliation(s)
- B Knezevic
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - D Sprigg
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - J Seet
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - M Trevenen
- Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - J Trubiano
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - W Smith
- Department of Immunology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Y Jeelall
- School of Medicine and Pharmacology, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - S Vale
- Drug Allergy Working Party, Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - R Loh
- Department of Clinical Immunology, Princess Margaret Hospital, Perth, Western Australia, Australia.,Pathwest Laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia
| | - A McLean-Tooke
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.,Pathwest Laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia
| | - M Lucas
- Department of Clinical Immunology, Royal Perth Hospital, Perth, Western Australia, Australia.,Pathwest Laboratory, Queen Elizabeth II Campus, Perth, Western Australia, Australia.,Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| |
Collapse
|
28
|
Carroll GJ, Makin K, Garnsey M, Bulsara M, Carroll BV, Curtin SM, Allan EM, McLean-Tooke A, Bundell C, Kemp ML, Deshpande P, Ihdayhid D, Coleman S, Easter T, Triplett J, Disteldorf T, Marsden CH, Lucas M. Undetectable Mannose Binding Lectin and Corticosteroids Increase Serious Infection Risk in Rheumatoid Arthritis. J Allergy Clin Immunol Pract 2017. [PMID: 28634103 DOI: 10.1016/j.jaip.2017.02.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infection is the leading cause of death in rheumatoid arthritis (RA). Corticosteroid (CS) use is a known and important risk factor for serious infections (SIs). Mannose binding lectin (MBL) is a genetically determined component of the innate immune system implicated in neonatal infections. OBJECTIVE Our aim was to determine whether MBL deficiency is a risk factor for SIs in RA and to compare it with CS use and also synthetic and biologic disease-modifying antirheumatic drug (DMARD) therapy. METHODS Data on 228 patients with RA were collected for up to 7 years (median = 5.9 years). Serum MBL concentrations were determined in all patients receiving synthetic (n = 96) or biologic (n = 132) DMARD therapy. RESULTS High rates of SIs were observed in RA irrespective of treatment (17%). Similar rates of SIs were observed in synthetic and biologic DMARD users. The rates of single and multiple SIs were similar, irrespective of the use of a biologic agent. Undetectable MBL (<56 ng/mL) concentrations and maintenance prednisolone at 10 mg per day or higher were associated with an increased risk for an SI, with incident risk ratio of 4.67 (P = .001) and 4.70 (P < .001), respectively. CONCLUSIONS Undetectable MBL and prednisolone confer a high risk for an SI. The use of biologic DMARDs did not confer substantial SI risk in this observational study. MBL deficiency is hitherto an unrecognized risk factor for an SI in RA.
Collapse
Affiliation(s)
- Graeme J Carroll
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia; Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia; ArthroCare, Mt Lawley, Western Australia, Australia.
| | - Krista Makin
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Maxine Garnsey
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Max Bulsara
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Bronwyn V Carroll
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Shona M Curtin
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Erin M Allan
- ArthroCare, Mt Lawley, Western Australia, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Monica L Kemp
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Pooja Deshpande
- School of Medicine, University of Western Australia, Human Anatomy and Biology, Perth, Western Australia, Australia
| | - Dana Ihdayhid
- Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | | | - Tracie Easter
- Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - James Triplett
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Timothy Disteldorf
- School of Medicine, University of Western Australia, Human Anatomy and Biology, Perth, Western Australia, Australia
| | - C Helen Marsden
- Department of Rheumatology, Fremantle Hospital, Fremantle, Western Australia, Australia; Department of Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michaela Lucas
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Clinical Immunology, Pathwest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; University of Western Australia, School of Medicine and Pharmacology, Pathology and Laboratory Medicine, Perth, Western Australia, Australia
| |
Collapse
|
29
|
Bundell C, Chandratilleke D, Griffiths S, Goulding M, Hollingsworth P, McLean-Tooke A. ASCIA-P70: IS TESTING FOR AQP4 ANTIBODIES IN CSF AND SERUM MORE SENSITIVE THAN SERUM ALONE? Intern Med J 2016. [DOI: 10.1111/imj.70_13197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christine Bundell
- PathWest Laboratory Medicine WA; Nedlands Western Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Australia
| | - Dinusha Chandratilleke
- PathWest Laboratory Medicine WA; Nedlands Western Australia
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
| | | | - Mark Goulding
- PathWest Laboratory Medicine WA; Nedlands Western Australia
| | - Peter Hollingsworth
- PathWest Laboratory Medicine WA; Nedlands Western Australia
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
| | - Andrew McLean-Tooke
- PathWest Laboratory Medicine WA; Nedlands Western Australia
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
| |
Collapse
|
30
|
Ekstrom C, Chandratilleke D, Hollingsworth P, McLean-Tooke A. ASCIA-P28: FEWER THAN 50% OF PATIENTS COMMENCING SCIT COMPLETE A 3 YEAR COURSE. Intern Med J 2016. [DOI: 10.1111/imj.28_13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Charlotta Ekstrom
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
| | - Dinusha Chandratilleke
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
- PathWest Laboratory Medicine WA; Nedlands Western Australia
| | - Peter Hollingsworth
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
- PathWest Laboratory Medicine WA; Nedlands Western Australia
| | - Andrew McLean-Tooke
- Immunology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia
- PathWest Laboratory Medicine WA; Nedlands Western Australia
| |
Collapse
|
31
|
Bundell C, Rojana-Udomsart A, Mastaglia F, Hollingsworth P, McLean-Tooke A. Diagnostic performance of a commercial immunoblot assay for myositis antibody testing. Pathology 2016; 48:363-6. [PMID: 27114370 DOI: 10.1016/j.pathol.2016.03.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/26/2015] [Accepted: 01/24/2016] [Indexed: 10/21/2022]
Abstract
The objective of this study was to establish a population based reference range for a commercial immunoblot assay detecting myositis specific autoantibodies (MSAs) and myositis associated autoantibodies (MAAs), and to assess the diagnostic performance of this reference range against the manufacturer's recommended ranges in a myositis patient cohort. A total of 124 patients from a myositis cohort and 197 healthy controls were serologically assessed using a commercial immunoblot containing eleven autoantigens (Jo-1, EJ, OJ, PL7, PL12, Mi-2, SRP, Ku, PMScl75, PMScl100 and Ro52) according to the manufacturer's instructions. Use of the manufacturer's reference ranges resulted in detection of MSAs in 19.4% of myositis patients and 9.1% of controls; MAAs were detected in 41.1% of myositis patients and 14.2% of controls. Reference values derived from the healthy control population resulted in significant differences in cut-off values for some autoantibodies, particularly Ro52 and PMScl75. Use of local reference ranges reduced detection of MSAs to 16.9% of myositis patients and 3% of healthy controls, with MAAs 23.4% of patients and 2% of healthy controls. Application of population based reference ranges resulted in significant differences in detection of MSAs and MAAs compared to the manufacturer's recommended ranges. Cut-off levels should be assessed to ensure suitability for the population tested.
Collapse
Affiliation(s)
- Chris Bundell
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Australia; School of Pathology and Laboratory Medicine, and University of Western Australia, Perth, Australia
| | - Arada Rojana-Udomsart
- Western Australian Neuroscience Research Institute, University of Western Australia, Perth, WA, Australia; Department of Medicine, Yala Hospital, Yala, Thailand
| | - Frank Mastaglia
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia
| | - Peter Hollingsworth
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Australia; School of Pathology and Laboratory Medicine, and University of Western Australia, Perth, Australia
| | - Andrew McLean-Tooke
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Perth, Australia.
| |
Collapse
|
32
|
Lucas M, Jeelall Y, Kavanagh S, Bundell C, Hew M, Wood BA, Joske D, McLean-Tooke A. B-cell small lymphocytic lymphoma associated with extremely high total IgE and cutaneous vasculitis. J Allergy Clin Immunol Pract 2016; 4:552-4. [PMID: 26883544 DOI: 10.1016/j.jaip.2015.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/24/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Michaela Lucas
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia.
| | - Yogesh Jeelall
- School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Simon Kavanagh
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Meilyn Hew
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Benjamin A Wood
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David Joske
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- Pathwest Laboratory Medicine, SCGH, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| |
Collapse
|
33
|
Davies JM, Solley GO, Smith WB, McLean-Tooke A, van Nunen SA, Smith PK, Timbrell VL, Upham JW, Langguth D. A Multicentre Cross-Sectional Survey of Allergic Sensitisation to Subtropical and Temperate Grass Pollens. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
34
|
Furlong E, Loh RK, Gong GWK, McLean-Tooke A. Reduced Macrophages IL-12 Production After Stimulation By BCG/INF-Gamma Suggestive Of Impaired INF-Gamma Pathway Signalling In a Child With Disseminated Atypical Mycobacterial Infection and History Of Chemotherapy For Langerhans Cell Histiocytosis. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
35
|
Tu J, McLean-Tooke A, Junckerstorff R. Increasing recognition of dermatomyositis with subcutaneous edema - is this a poorer prognostic marker? Dermatol Online J 2014; 20:21244. [PMID: 24456947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 06/03/2023] Open
Abstract
Subcutaneous edema as a presenting feature of dermatomyositis has infrequently been described and is thought to signify a more aggressive disease course. We report a case involving a 38-year-old man who presented with significant subcutaneous edema involving his neck and upper body; he later developed clinical features and biopsy results consistent with dermatomyositis. Only sixteen previous cases of dermatomyositis with subcutaneous edema involving adults have been published in the literature and we aim to review disease progression, prognosis, and optimal treatment of the condition.
Collapse
|
36
|
Tu J, McLean-Tooke A, Junckerstorff R. Increasing recognition of dermatomyositis with subcutaneous edema – is this a poorer prognostic marker? Dermatol Online J 2014. [DOI: 10.5070/d3201021244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
37
|
O'Sullivan M, McLean-Tooke A, Loh RKS. Antinuclear antibody test. Aust Fam Physician 2013; 42:718-721. [PMID: 24130974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The antinuclear antibody (ANA) test is widely used as a serological marker of autoimmune disease. Antinuclear antibodies are immunoglobulins or antibodies that bind to one or more antigens expressed within the nucleus of human cells. Used selectively, the ANA test can be a useful laboratory tool to help confirm or exclude the diagnosis of systemic rheumatic disease. However, the relatively high prevalence of ANAs in other inflammatory conditions, as well as healthy individuals, can make a positive result difficult to interpret.
Collapse
Affiliation(s)
- Michael O'Sullivan
- MBBS, FRACP, FRCPA, is a Consultant Immunologist, Fremantle Hospital and Princess Margaret Hospital for Children, Western Australia
| | | | | |
Collapse
|
38
|
Abstract
BACKGROUND The postmortem diagnosis of anaphylaxis remains difficult due to the lack of specific biomarkers. Mast cell tryptase (MCT) levels are used as a marker of mast cell degranulation in living patients and elevated levels have also been described in postmortem serum samples in anaphylaxis-associated deaths, although elevated levels may also be seen in non-anaphylaxis-associated deaths. OBJECTIVE To investigate the effects of cause of death, site of blood sampling, degree of sample haemolysis and the presence of opiates on postmortem MCT levels. METHOD We obtained sera from three collection sites from 189 non-suspicious coronial postmortems and aortic samples from 10 anaphylactic deaths to characterise postmortem MCT. RESULTS MCT were elevated (>11.4 μg/L) in 57% of aortic samples, 58% of femoral samples and 30% of subclavian samples. In aortic samples, there were significantly higher levels of MCT in anaphylaxis-associated deaths compared with other causes of death. Aortic MCT levels >110 μg/L had a sensitivity of 80% and specificity of 92.1% for anaphylaxis-associated deaths. There was a significant correlation between MCT and degree of sample haemolysis but no correlation with the presence of opiates. CONCLUSIONS Moderately elevated MCT levels are common in postmortem sera. Aortic values >110 μg/L may support a diagnosis of anaphylaxis-associated death, although the diagnosis should not be based on this test alone. There was significant variation between sample sites and reference ranges for individual sample sites should be established.
Collapse
Affiliation(s)
- Andrew McLean-Tooke
- Department of Clinical Immunology, PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, , Perth, Western Australia, Australia
| | | | | | | | | |
Collapse
|
39
|
Kulkarni H, Lenzo N, McLean-Tooke A. Causality of rhabdomyolysis and combined tetanus, diphtheria and acellular pertussis (Tdap) vaccine administration. J Clin Pharmacol 2013; 53:1099-102. [PMID: 23913623 DOI: 10.1002/jcph.145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/30/2013] [Indexed: 01/30/2023]
Affiliation(s)
- Hemant Kulkarni
- Department of Nephrology and Transplantation, Fremantle Hospital, Fremantle, Western Australia, Australia
| | | | | |
Collapse
|
40
|
Loh RKS, Vale S, McLean-Tooke A. Quantitative serum immunoglobulin tests. Aust Fam Physician 2013; 42:195-198. [PMID: 23550242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
What is the test? Immunoglobulins are protein molecules. They contain antibody activity and are produced by the terminal cells of B-cell differentiation known as 'plasma cells'. There are five classes of immunoglobulin (Ig): IgG, IgM, IgA, IgD and IgE. In normal serum, about 80% is IgG, 15% is IgA, 5% is IgM, 0.2% is IgD and a trace is IgE. Quantitative serum immunoglobulin tests are used to detect abnormal levels of the three major classes (IgG, IgA and IgM). Testing is used to help diagnose various conditions and diseases that affect the levels of one or more of these immunoglobulin classes. Some conditions cause excess levels, some cause deficiencies, and others cause a combination of increased and decreased levels. IgD and IgE will not be discussed in this article.
Collapse
Affiliation(s)
- Richard K S Loh
- Immunology Department, Princess Margaret Hospital for Children, Subiaco, Western Australia.
| | | | | |
Collapse
|
41
|
McGettigan BD, Hew M, Phillips E, McLean-Tooke A. Sulphadiazine-induced renal stones in a 63-year-old HIV-infected man treated for toxoplasmosis. BMJ Case Rep 2012; 2012:bcr-2012-006638. [PMID: 23001098 DOI: 10.1136/bcr-2012-006638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 63-year-old man was admitted for investigation of blurred vision and multiple ring-enhancing lesions on cranial MRI. Histopathological examination of tissue obtained at brain biopsy showed multiple Toxoplasma gondii cysts. He was started on a combination of sulphadiazine and pyrimethamine for cerebral toxoplasmosis and was subsequently diagnosed with HIV-1 infection. He then developed acute renal failure and flank pain and was diagnosed with bilateral vesico-uretric calculi requiring bilateral stent insertion. The retrieved renal calculi were negative for the common stones that are routinely tested for in our laboratory and had the macroscopic characteristics of a sulphadiazine stone. His renal failure responded to cessation of the sulphadiazine.
Collapse
|
42
|
McLean-Tooke A, Barge D, Spickett GP, Gennery AR. Flow Cytometric Analysis of TCR Vβ Repertoire in Patients with 22q11.2 Deletion Syndrome. Scand J Immunol 2011; 73:577-85. [DOI: 10.1111/j.1365-3083.2011.02527.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
43
|
Abstract
This review looks at the main issues around immediate hypersensitivity and the role and limitations of testing. The majority of literature on antibiotic hypersensitivity relates to β-lactam antibiotics, mainly because of the heavy usage of this class of drugs. Concerns around cross-reactivity always worry clinicians, particularly in the emergency situation. Reasonable data now exist in relation to β-lactam antibiotics and derivatives, which enable appropriate risk management to be undertaken. The available literature for other classes of antibiotics is also discussed.
Collapse
Affiliation(s)
- Andrew McLean-Tooke
- Department of Immunology, Fremantle Hospital and PathWest Laboratory Medicine, Fremantle, Perth, Australia.
| | | | | | | |
Collapse
|
44
|
Gordins P, McLean-Tooke A, Spickett GP. The role of omega-5 gliadin-specific IgE test in diagnosing exercise-induced wheat allergy. Int Arch Allergy Immunol 2010; 155:93-4. [PMID: 21109753 DOI: 10.1159/000318740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
45
|
McLean-Tooke A, Aldridge C, Waugh S, Spickett GP, Kay L. Methotrexate, rheumatoid arthritis and infection risk--what is the evidence? Rheumatology (Oxford) 2009; 48:867-71. [DOI: 10.1093/rheumatology/kep101] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
46
|
Gennery AR, Slatter MA, Rice J, Hoefsloot LH, Barge D, McLean-Tooke A, Montgomery T, Goodship JA, Burt AD, Flood TJ, Abinun M, Cant AJ, Johnson D. Mutations in CHD7 in patients with CHARGE syndrome cause T-B + natural killer cell + severe combined immune deficiency and may cause Omenn-like syndrome. Clin Exp Immunol 2008; 153:75-80. [PMID: 18505430 DOI: 10.1111/j.1365-2249.2008.03681.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
More than 11 genetic causes of severe combined immunodeficiency (SCID) have been identified, affecting development and/or function of T lymphocytes, and sometimes B lymphocytes and natural killer (NK) cells. Deletion of 22q11.2 is associated with immunodeficiency, although less than 1% of cases are associated with T-B + NK + SCID phenotype. Severe immunodeficiency with CHARGE syndrome has been noted only rarely Omenn syndrome is a rare autosomal recessive form of SCID with erythroderma, hepatosplenomegaly, lymphadenopathy and alopecia. Hypomorphic recombination activating genes 1 and 2 mutations were first described in patients with Omenn syndrome. More recently, defects in Artemis, RMRP, IL7Ralpha and common gamma chain genes have been described. We describe four patients with mutations in CHD7, who had clinical features of CHARGE syndrome and who had T-B + NK + SCID (two patients) or clinical features consistent with Omenn syndrome (two patients). Immunodeficiency in patients with DiGeorge syndrome is well recognized--CHARGE syndrome should now be added to the causes of T-B + NK + SCID, and mutations in the CHD7 gene may be associated with Omenn-like syndrome.
Collapse
Affiliation(s)
- A R Gennery
- Department of Paediatric Immunology, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
McLean-Tooke A, Barge D, Spickett GP, Gennery AR. T cell receptor Vbeta repertoire of T lymphocytes and T regulatory cells by flow cytometric analysis in healthy children. Clin Exp Immunol 2007; 151:190-8. [PMID: 17983445 DOI: 10.1111/j.1365-2249.2007.03536.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Evaluation of the T cell receptor (TCR) Vbeta repertoire by flow cytometric analysis has been used for studying the T cell compartments for diseases in which T cells are implicated in the pathogenesis. For the interpretation of these studies information is needed about Vbeta usage in healthy individuals and there are few data for normal usage in paediatric populations. We examined the T lymphocyte (sub)populations in 47 healthy controls (age range: 3 months-16 years). We found non-random Vbeta usage with skewed reactivity of some families towards CD4+ or CD4- T cells. Importantly, there appeared to be no significant change in Vbeta usage according to age group. Some controls showed expansions in some Vbeta families, although incidence of such expansions was low. We went on to examine the repertoire of CD4+CD25(Bright) T regulatory cells in 25 healthy controls. We found overlapping quantitative usage for each of the Vbeta families between CD4+CD25- and CD4+CD25(Bright) T cells. However, there was a significant preferential usage for five Vbeta families and decreased usage of two Vbeta families in the CD4+CD25(Bright) T cells, suggesting that although they overlap there may be subtle but important differences in the TCR repertoire of T regulatory cells.
Collapse
Affiliation(s)
- A McLean-Tooke
- Department of Immunology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | | | | | | |
Collapse
|
48
|
Abstract
22q11.2 deletion syndrome is the commonest chromosome deletion syndrome. 22q11.2 deletion may result in variable clinical phenotypes which may differ even between patients with identical deletions. Abnormal pharyngeal arch development results in defects in the development of the parathyroid glands, thymus and conotruncal region of the heart. Defective thymic development is associated with impaired immune function. 'Complete' DiGeorge syndrome with total absence of the thymus and a severe T-cell immunodeficiency accounts for <0.5% of patients. The majority of patients with 22q11.2 deletion syndromes have 'partial' defects with impaired thymic development rather than complete absence with variable defects in T-cell numbers. Immunodeficiency in these patients is not solely due to T-cell deficiency and abnormalities of T-cell clonality or impairment of proliferative responses may play a role. Humoral deficiencies including defects in the B-cell compartment have also been identified in these patients. 22q11.2 deletion syndrome patients are at increased risk of a variety of autoimmune diseases. A number of immune defects may predispose to the development of autoimmunity in these patients including increased infection, impaired development of natural T-regulatory cells and impaired thymic central tolerance.
Collapse
Affiliation(s)
- A McLean-Tooke
- Department of Immunology, Royal Victoria InfirmaryDepartment of Paediatric Immunology, Newcastle General Hospital, Newcastle-Upon-Tyne, UK
| | - G P Spickett
- Department of Immunology, Royal Victoria InfirmaryDepartment of Paediatric Immunology, Newcastle General Hospital, Newcastle-Upon-Tyne, UK
| | - A R Gennery
- Department of Immunology, Royal Victoria InfirmaryDepartment of Paediatric Immunology, Newcastle General Hospital, Newcastle-Upon-Tyne, UK
| |
Collapse
|
49
|
Abstract
A 59-year-old lady presented with recurrent angioedema without urticaria. The clinical history and examination were consistent with an acquired C1 esterase deficiency secondary to lymphoproliferative disease. Despite a low C1 esterase level, the C4 level assayed by nephelometry on our automated analyser was normal. Analysis using different nephelometric analysers revealed consistently low C4, despite consistent normal readings in our analyser. Further investigation revealed an IgM-kappa paraprotein that seemed to interfere with both this and haematology coagulation assays. Splenic marginal zone lymphoma was confirmed on bone marrow biopsy. Monoclonal paraproteins may interfere with nephelometric, turbidimetric and immunological assays in a non-antibody-specific manner and should be considered when there are unusual or unexpected results, particularly in a patient with lymphoproliferative disease.
Collapse
Affiliation(s)
- Andrew McLean-Tooke
- Department of Immunology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
| | | | | | | |
Collapse
|