Background: Increased intestinal permeability, either due to the exposure to antigens in asthmatic patients or due to a barrier defect, play a critical role in susceptibility to environmental allergens. House dust mites allergy occurs more commonly than any other allergens among Egyptian asthmatic patients.Aim:To assess the relation between serum zonulin level as a marker of increased intestinal permeability and the severity of house dust mites allergic asthma.Methods:A case control study which included 48 house dust mites allergic asthma and 48 healthy control subjects attending the allergy and immunology unit, microbiology and immunology department, Faculty of medicine, Zagazig University. Results:On comparing the 2 studied groups, there was a statistically significant difference between the 2 groups concerning serum IgE and serum zonulin levels ( p=0.000, 0.000 respectively)The mean serum zonulin was equal to 258.3±153.01 ng/ml in the asthmatic group and 80±13 ng/ml in the control group. Serum zonulin level significantly increased with the increase of asthma severity (p˂0.001). The cut off value of serum zonulin was ≥ 198 ng/ml, and the area under the curve was 0.76. It displayed sensitivity equal to 80% and specificity equal to 71.4%. Its negative predictive value was equal to 83.3%. Conclusion: Intestinal barrier dysfunction contributes in the pathogenesis of allergic asthma. Serum zonulin level reflects an increase in intestinal permeability and acts as prognostic factor of severity in Asthma. Correction of the gut barrier defect may be an additional novel approach for Asthma.

Background Increased intestinal permeability, either due to the exposure to antigens in asthmatic patients or due to a barrier defect, plays a critical role in susceptibility to environmental allergens. House dust mite allergy occurs more commonly than any other type of allergy among Egyptian asthmatic patients. Aim To assess the relation between serum zonulin level as a marker of increased intestinal permeability and the severity of house dust mite allergic asthma. Methods A case–control study which included 48 patients with house dust mite allergic asthma and 48 healthy control subjects attending the Allergy and Immunology Unit, Microbiology and Immunology Department, Faculty of Medicine, Zagazig University. Results A statistically significant difference was detected between the two studied groups with respect to serum IgE and serum zonulin levels (p ˂ 0.001 and ˂ 0.001, respectively). The mean serum zonulin was equal to 258.3 ± 153.01 ng/ml in the asthmatic group and 80 ± 13 ng/ml in the control group. Serum zonulin level significantly increased with the increase of asthma severity (p ˂ 0.001). The cut off value of serum zonulin was ≥ 198 ng/ml, and the area under the curve was 0.76. It displayed sensitivity equal to 80% and specificity equal to 71.4%. Its negative predictive value was equal to 83.3%. Conclusion Intestinal barrier dysfunction contributes to the pathogenesis of allergic asthma. Serum zonulin level reflects an increase in intestinal permeability. Zonulin acts as prognostic factor of severity in asthma. Correction of the gut barrier defect may have a potential positive prognostic effect in asthma.

Background and Aims Chronic Urticaria is a common disorder which is defined by recurrent occurrence of wheals and sometimes angioedema. It has a notable influence on the patient’s quality of life. Regulation of the immune system is one of the important roles of the gut microbiota. Objective Comparing the frequency and bacterial load of Lactobacillus between patients with chronic urticaria and healthy controls. Methods Forty patients with chronic urticaria were recruited from the outpatient clinic of Allergy and Clinical Immunology at Ain Shams University Hospitals and 40 age and sex matched healthy individuals were included in the present study. Stool samples were analyzed for determining the frequency and bacterial load of Lactobacillus. Results There was a difference among the frequency of detectable Lactobacillus in stool samples of patients with chronic urticaria and healthy controls. The relative amounts of Lactobacillus were significantly higher in fecal samples from controls compared to patients with chronic urticaria (P < 0.001). Conclusion Our study showed that some types of gut microbiota are found in normal individuals in a higher amounts than patients with chronic spontaneous urticaria.

This study evaluated the effectiveness, proper dosage and possible response of OMALIZUMAB (Biologics) for Chronic Idiopathic Urticaria (CIU) patients in KSA with antihistamine refractory CIU disease related quality of life. METHODS: The study was prospective and descriptive in nature. Omalizumab was used in those patients who did not respond to up dosing of Antihistamine, steroids and cyclosporine. Omalizumab is recombinant humanized monoclonal antibody against human IgE and has good safety profile due to biological nature of the drug. All patients administered omalizumab must be observed for 2 hours for adverse effects. Six month's trial of omalizumab 300 mg every 4 weeks, among patients with CIU. Total 26 patients with mean age 48 including both sexes. RESULTS: Out of 26 patients, 22 patients (84%) responded well to 300 mg omalizumab injection every month, whereas 4 patients need up dosing more than 300 mg .In 300 mg group eight patients achieved complete symptoms control without antihistamine intake and others required antihistamine without prednisolone and cyclosporine .Though 3 patients didn't achieved complete absence of symptoms, cyclosporine and oral corticosteroids could be discontinued. Only 1 patient reported adverse effect like Headache, Dizziness and fatigue CONCLUSIONS: Omalizumab at an initial dosage of 150 mg was not effective treatment in CIU up dosing to 300 mg was required to achieve satisfactory outcomes. It can be used after failure of other therapies. Omalizumab binds with free IgE antibodies and reduces the circulating levels of free IgE. This reduction in free IgE prevents mast cell degranulation.

Background The house dust mites (HDM) constitute a major cause of allergic diseases all over the world. Genes encoding interleukins 12B and 17A which determine the course of T cell-mediated immune response are prime candidates as allergic disease susceptibility. The purpose of this study was to evaluate whether a single-nucleotide polymorphisms (SNP) of interleukins 12B + 1188A/C (rs3212227) and 17A −197G/A (rs2275913) confers susceptibility to HDM allergic diseases. Through a case-control study, 120 subjects served as 60 dust mites' allergic patients and 60 healthy non-allergic controls. Total immunoglobulin (Ig) E level, eosinophilic count, serum interleukins 4, 10, 12B, and 17A levels for the studied subjects were measured. Then, genotyping of single-nucleotide polymorphisms (SNPs) at +1188A/C for IL12B and −197G/A for IL17A gene were conducted using restriction fragment length polymorphisms (RFLP-PCR). Results The present study showed that in HDMs' allergic subjects there was a significant increase in IL12B (+1188 A/C) and IL17A (−197 G/A) genotype variants compared to that of the controls. There was a significant increase in total IgE levels, eosinophil counts, and the levels of both IL-4 and IL-17A, while IL12B was significantly lower in patients compared to that of the controls. There was no significant difference in IL-10 levels between patients and controls.                                                                             Conclusion Our findings indicate that IL12B (+1188 A/C) and IL17A (−197G/A) might be associated with an increase in the susceptibility to dust mites’ allergic patients.