الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Type 1 diabetes is a chronic disease characterized deficiency in
insulin secretion due to the autoimmune damage of the beta cells in the
pancreas.
Atopy refers to the genetic tendency to develop allergic diseases
such as allergic rhinitis, asthma and atopic dermatitis (eczema). Atopy is
typically associated with heightened immune responses to common
allergens, especially inhaled allergens and food allergens.
T helper cells has major role in pathology of of atopic and
autoimmune diseases. T helper cells diffrentiated according to the
cytokines they secrete into Th1 cells that produce interferon-gamma,
interleukin-2, IL-12 and tumor necrosis factor-alpha and are involved in
intracellular infections and autoimmune diseases and Th2 cells that
produce IL-4, IL-5, IL-13, and IL-10 and are involved in extracellular
infections and atopic diseases.
A mature naïve CD4+ T lymphocyte has ability for deffrentiation
into Th1 or Th2 cells. Once a T cell immune response begins to develop
along one pathway, it tends to progressively polarize in that direction.
Th1 and Th2 cells reciprocally inhibit each other by production of their
specific cytokines.
Th1 cells mediate autoimmune diseases as type 1 diabetes mellitus;
rheumatoid arthritis and autoimmune thyroiditis. In contrast, Th cells
deffrentiate towards Th2 cells in atopic diseases such as asthma, eczema
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and hay fever, exposure to aero-allergens promotes the differentiation in
direction of Th2 which causes production of IgE against allergens.
The aim of the study was conducted to assess immunological
relation between atopic disease and type 1 diabetes mellitus using a
written questionnaire, It was adopted from American Academy of
Dermatology Journal, (March 2008), from 200 children with insulin
dependent diabetes mellitus attending pediatric clinic, Institute of
Diabe. , and 200 non diabetic children attending pediatric clinic, New
Cairo hospital and it was aided by their relative information.
All children were given a written questionnaire including personal
data (name, age, sex, residence), history as regards asthma and other
atopic diseases, complementary questions for risk factors, were taken into
consideration as (history of breast feeding, father education,
environmental conditions and exposure to tobacco smoke).
The results of this questionnaire among studied children showed
that: prevalence of bronchial asthma was 8.5% are asthmatic among cases
but among control children was 35.5% are asthmatic, so cases had lower
frequency of asthma compared to controls with statistically significant
difference between both groups.
Also this study shows that cases had lower percentage of
symptoms of asthma compared to controls with statistically significant
difference between both groups.
No allergic conjunctivitis among cases was found but was 2 %
among controls, allergic rhinitis among cases was 1.5% with statistically
significant difference between both groups but among control is 16.5%,
no significant difference between both groups.
Skin allergy among cases was 15.5% but among control was
18.5%, so cases had lower frequency of atopic dermatitis compared to
controls with no statistically significant difference between both groups.
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This study shows no statistically significant difference between
both groups as regard type of lactation, the study found that 93% of cases
are breast feeding and 90% of controls are breast feeding.
The socioeconomic characteristics of studied children showed that
higher social classes had higher frequency of atopy with statistically
significant difference between both groups.
This study shows that cases had lower frequency of the
interference with daily activities compared to controls with statistically
significant difference between both groups.
This study shows no statistically significant difference between
both groups as regard effect of kind of food, 12.5% of cases are affected
by kind of food and 14.5 % of controls are affected by kind of food in
presence of atopical symptoms.
This study shows no statistically significant difference between
both groups as regard presence of smoker at home, 51% of cases were
exposed to tobacco smoke, 56.5% of controls were exposed to tobacco
smoke.
It was found that cases had a lower % of family history of atopy
with statistically significant difference between both groups,28% of
cases have family history of atopy and 53% of controls have family
history of atopy.
This study indicates that positive atopy cases had higher frequency
of positive family history of atopy compared to negative group with
statistically significant difference in between.
This study shows that insulin dose among positive atopy cases was
lower compared to negative atopy cases group with no significant
difference.
Conclusion: patients with T1D have a lower prevalence of atopic
symptoms, mainly asthma and allergic rhinitis which is consistent with
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the Th1/Th2 polarization concept. Additional studies are needed to
evaluate the effect of atopy and allergic diseases on glycemic control and
long-term complications in patients with type 1 DM. It is possible that
further research may allow using immunotherapy in type 1 diabetes.
RECOMMENDATIONS
Additional studies are needed to evaluate the effect of atopy and
allergic diseases in glycemic control and long-term complications in
patients with type 1 DM.
Further studies are needed to understand why allergic symptoms
among children with DM1 have decreased. Such studies will need to
take into account confounding variables, such as the sequence of
occurrence of allergic symptoms; environmental factors, including
different types of early childhood infections, markers of immune
response or genetic differences, in atopic and nonatopic patients with
DM1.