الفهرس 
pathologyOnly 14 pages are availabe for public view
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Abstract
Bronchial asthma is a common lung disease encountered in
clinical practice of medicine. Mould induced asthma is considered a
common type of allergic asthma due to exposure to fungal
aeroallergen with type 1 hypersensitivity.
After contact with a specific allergen, mast cell degranulates
and induces the early phase asthma consisting of smooth muscle
contraction and increased vascular permeability, followed by late
phase reaction, characterised by inflammatory cellular infilterates in .
the bronchial wall. These cells included mast cells, basophils,
eosinophils, neutrophils, platelets, lymphocytes, macrophages and
epithelial cells, all are involved in the pathogenesis of the
inflammation in asthma.
Late asthmatic reaction with subsequent airway inflammation
is associated with increase in airway responsiveness. Eosinophils and
neutrophils have been found in increased numbers in bronchoalveolar
fluid.
,- The mechanism behind the enhancement of eosinophil and
neutrophil activation in asthma is not known.
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SUMMARY AN.’ CIJNCWSION
132
Changes in their function and activity including aggregation,
degranulation, adherence and enhanced expression of surface
receptor in particular FC and complement receptors. These various
properties are all potentially important in the asthmatic response for
the recruitment and activation of inflammatory cells.
In our work, we aimed to study some of regulatory
mechanisms modulating the asthmatic process mediated by
eosniophils and neutrophils via their FCy and complement receptor
(CRl) expression character, and to assess their migratory response to
histamine, which is one of main mediators released during early
phase of asthma (i.e. histamine chemotaxis).
We also extended our work to evaluate serum or plasma
factors influence on eosinophil and neutrophil functions through FC
and complement receptor expression and also upon their chemotactic
activities toward histamine in atopic asthmatic subjects sensitive to
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moulds.
In a period of 8 months, from August 1992 to March 1993
(out of pollen season), our study was performed and included:
1] Atopic patients with mould induced asthma selected initially by
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skin pri,ck test and high levels of total serum IgE ~ 100 IU/mL .
as group (A).
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SUMMARY AND>CONCWSION 233
2] Contr~l _,~ubjects, ten apparently healthy volunteers with no
respiratory tract infection, allergy, or other atopic manifestations.
They had negative skin prick result and total serum IgE was
below 100 IU/mL and considered group B. Both groups of
subjects after questionnaire approach and good history taking,
were subjected to :
1- Thorough clinical examination.
2- Radiological examinaions of head air sinuses and chest.
3- Some pulmonary (unction tests (FEV}, FVC) and ECG trace.
4- Laboratory investigations which included:
a. Stool and urine analysis : three specimens were studied for
parasite’S ova identification particularly intestinal and urinary
bilharsiasis, and to detect renal troubles.
b. Sputum examination and culture for fungi.
5- Peripheral blood studies:
a. Measurement of total serum IgE by ELISA technique.
b. Total white blood cell, neutrophil, eosinophil cell count.
c. Immunological studies:
i. Estimation of Fey receptors born on circulating eosinophils and
neutrophils.
SUMMARY AND CONCLUSION 234
ii. Estimation of complement receptors (CRl) bom on circulating
eosinophils and neutrophils by rosette technique (Bianco
technique).
iii. Assessment of chemotactic properties of eosinophils and
neutrophils to histamine (histamine chemotaxis) through
agarsoe gel.
iv. Evaluation of serum factors on modulation of FCy and
complement CRI receptor expression and histamine
chemotaxis in vitro.
- Results were expressed as mean ± standard deviation, and the
student t-test.was used for analysis.
Our observations andjindings were summarized asfollows :
Among 163 patients with atopic asthma, thirty asthmatics
sensitive only to mould extracts were selected by skin prick method,
and participated in our study. All mould sensitive asthmatics met the
criteria of ~ 15% airway reversibility with FEVl% ranged from 65%
to 75% of the predicted value i.e. with mild and moderate asthma.
Their atopic status was further confirmed by high levels of total
serum IgE antibodies, they were referred as group A. Patients III
group A WHefurther subclassified into:
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SUMMARY AND CONCLUSION
235
1) According to phases of skin prick reactivity subgroup AI, these
patients with isolated early skin response and included 13
patients, and subgroup Az, who had early as well as late skin
response (dual reaction) including 17 patients.
2) According to pattern of mould allergy by skin prick method.
Patients-were subdivided into subgroup A3, those asthmatic
patients with single mould allergy (19 patients) and subgroup
A4 patients with skin allergy to multiple moulds and constituted
(11 patients) .
• Mould sensitive asthmatics in group A in our study represented
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18.4% of all atopic asthmatics in Benha area (Egypt). Group A
included 16 males and 14 females their ages ranged from 12 to 45
years in comaprison to control group which included ten apparently
healthy individuals, they had no respiratory tract infection or
allergy other atopic manifestations, 6 males and 4 females were
included, with ages ranged from 17 to 38 years and were referred as
group B.
• 70% of patients in group A were living in rural areas, and 30% were
living in urban area. Farmers and house wives were the main
subjects having mould asthma.
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SUMMARY AND CONCWSION 236
• Aspergillus species either alone or in combination with
Cladosporium and Alternaria formed the main moulds inducing
asthma, where Fusarium, Candida and Rhizopus species constituted
the least kinds of moulds causing asthma in both sexes.
• Allergic rhinitis and skin eczema were the common atopic features
associated with asthma in 23% and 20% of subjects in group A
while allergic conjunctivitis was absent in both sexes.
• 50% of patients in group A had no accompanying atopic manifestations.
The total serum IgE antibodies was significantly higher in
asthmatics in relation to IgE levels in control subjects. Patients with
dual skin reactivity (subgroup A2) had higher levels of total IgE in
comparison to asthmatics with isolated skin response (AI). Total
serum IgE levels were not significant among asthmatics in groups
A3 and A<I’
• Eosinophilia was a predominant feature in all asthmatics of group A.
with comparison to subjects in group B, and more observed in
patients of subgroup A2 of dual skin response than patients in
subgroup A] with single skin response. Eosinophilia had no much
difference among patients in subgroups A3 and A.4.
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SUMMARY ANf)”CONCWSION 237
Immunological Findings:
A) Fey receptor expression:
1] Eosinophils : isolated from peripheral blood of mould induced
asthma patients (group A) showed non significant expression of
FCy receptors in comparison to eosinophils isolated from control
group in vitro. But there was an enhancement of FCy receptor
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expression on eosinophils in subgroup A2 than eosinophils in
subgroup Ar- While FCy receptor expression on eosinophils was
not significant among patients in subgroups A3 and A4.
2] Neutrophils : in asthmatic subjects showed non significant
receptor expression of FCy in relation to neutrophils in group B.
While enhancement of FCy receptor expression was observed in
patients of dual skin response A2 and of multiple mould allergy in
subgroupAa.
3] Serum factors influence on Fey receptor:
Seraof asthmatics in group A had a significant suppressive
effect on expression of FCy receptors on eosinophils and neutrophils,
but actual suppression was not demonstrated due to priming effect. .
There was non significant FCy receptor expression on eosinophils and
neutrophils in subgroup Al and A2.
SUMMARY AND CONCWSION 238
B) Complement receptor (CRI) expression:
1] We had found an enhancement of complement receptors CRI
expression on circulating eosinophils and neutrophils in group A
with co.nparison to same cells in group B.
2] Enhancement was also present on both cell types in patients of
group 1\4. While CRI expression had no much difference in both
cell types in subgroups A, and A2.
3] As regard, serum effect, there was a significant enhancement
induced by patient sera on control eosinophils and neutrophils.
While serum factors did not show any difference in complement
receptor expression on both cell types of group A1 and A2·
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C) Histamine Chemotaxis:
1] As regard eosinophil and neutrophil: Chemoattraction toward
histamine, we had found that these cells in our asthmatic subjects
showed positive chemotaxis toward histamine more than cells in
subjects of group B.
SUMMARY AND CONCLUSION 239
2] After incubation with patient and healthy sera we concluded that
patient sera had made control eosinophil and neutrophil more
responsive to histamine chemotaxis, while healthy sera inhibited
control eosinophil and neutrophil histamine chemotaxis.
Eosinophils and neutrophils in patients of dual skin response (Az)
showed more chemoattraction toward histamine than cells in
group ~AI, in patients of group A4 than cells in patients of group.