tacrolimus and Eosinophilia

Morphea, also known as localized scleroderma, encompasses a group of idiopathic sclerotic skin diseases. The spectrum ranges from relatively mild phenotypes, which generally cause few problems besides local discomfort and visible disfigurement, to subtypes with severe complications such as joint contractures and limb length discrepancies. Eosinophilic fasciitis (EF, Shulman syndrome) is often regarded as belonging to the severe end of the morphea spectrum. The exact driving mechanisms behind morphea and EF pathogenesis remain to be elucidated. However, extensive extracellular matrix formation and autoimmune dysfunction are thought to be key pathogenic processes. Likewise, these processes are considered essential in systemic sclerosis (SSc) pathogenesis. In addition, similarities in clinical presentation between morphea and SSc have led to many theories about their relatedness. Importantly, morphea may be differentiated from SSc based on absence of sclerodactyly, Raynaud's phenomenon, and nailfold capillary changes. The diagnosis of morphea is often based on characteristic clinical findings. Histopathological evaluation of skin biopsies and laboratory tests are not necessary in the majority of morphea cases. However, full-thickness skin biopsies, containing fascia and muscle tissue, are required for the diagnosis of EF. Monitoring of disease activity and damage, especially of subcutaneous involvement, is one of the most challenging aspects of morphea care. Therefore, data harmonization is crucial for optimizing standard care and for comparability of study results. Recently, the localized scleroderma cutaneous assessment tool (LoSCAT) has been developed and validated for morphea. The LoSCAT is currently the most widely reported outcome measure for morphea. Care providers should take disease subtype, degree of activity, depth of involvement, and quality-of-life impairments into account when initiating treatment. In most patients with circumscribed superficial subtypes, treatment with topical therapies suffices. In more widespread disease, UVA1 phototherapy or systemic treatment with methotrexate (MTX), with or without a systemic corticosteroid combination, should be initiated. Disappointingly, few alternatives for MTX have been described and additional research is still needed to optimize treatment for these debilitating conditions. In this review, we present a state-of-the-art flow chart that guides care providers in the treatment of morphea and EF.

Topics: Administration, Cutaneous; Administration, Oral; Algorithms; Biopsy; Calcitriol; Dermatologic Agents; Diagnosis, Differential; Disease Progression; Drug Therapy, Combination; Eosinophilia; Evidence-Based Medicine; Fasciitis; Glucocorticoids; Humans; Methotrexate; Phototherapy; Practice Guidelines as Topic; Randomized Controlled Trials as Topic; Scleroderma, Localized; Skin; Tacrolimus; Treatment Outcome; United States

Eosinophilic folliculitis (EF) comprises classic eosinophilic pustular folliculitis (EPF), human immunodeficiency virus (HIV)-related EF, and infantile EPF subtypes. A fourth proposed subtype describes EF associated with hematologic malignancy. Recently, EF has occurred after bone marrow or stem cell transplantation (SCT).. We report a unique case of EF after haploidentical allogeneic SCT for acute lymphoblastic leukemia (ALL) and review the literature for similar cases.. A 56-year-old, HIV-negative ALL patient presented with an intensely pruritic papulopustular eruption. He had undergone haploidentical allogeneic SCT 65 days earlier, which he had tolerated well. Histopathology revealed a moderately dense perifollicular and perivascular lymphocytic infiltrate with many eosinophils extending from the superficial dermis to the subcutaneous fat. Fungal stains were negative. These findings were highly consistent with EF.. Therapy with a class II topical corticosteroid ointment, oral doxepin, and emollients achieved near-resolution of the lesions within eight weeks. Transition to topical tacrolimus 0.1% ointment applied twice daily to residual lesions yielded complete clearance by 12 weeks with mild post-inflammatory hyperpigmentation. The patient's ALL remains in remission.. A fourth proposed subtype of EF is associated with HIV-negative hematologic disease. This subtype is distinguished by a predictable timeframe to presentation and a relatively rapid response to therapy. Although EF is an important consideration in all patients with hematologic malignancy, clinically heightened suspicion is warranted during the 2-3 months after transplant.

Topics: Adrenal Cortex Hormones; Doxepin; Eosinophilia; Folliculitis; Histamine Antagonists; Humans; Immunosuppressive Agents; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Stem Cell Transplantation; Tacrolimus

Type I allergies have repeatedly been reported after solid organ transplantation despite T cell-targeted immunosuppressive therapy. A causal relationship with tacrolimus has been proposed.. The present study directly compared the occurrence of allergic sensitization and disease under tacrolimus- vs. cyclosporin A-based immunosuppressive therapy.. The prevalences of IgE-mediated sensitization and allergy were assessed in a cross-sectional study of kidney-transplanted adults receiving tacrolimus (n = 100) or cyclosporin A (n = 100).. included a standardized questionnaire, skin prick test and measurement of total and specific IgE against common nutritive and inhalant allergens. Results The prevalence of sensitization was significantly higher in the tacrolimus- than in the cyclosporin A-treated group (34%, n = 34, vs. 20%, n = 20; P = 0.026). The rate of clinically relevant allergy in patients receiving tacrolimus was twice that in patients receiving cyclosporin A (15%, n = 15, vs. 8%, n = 8; P = 0.12). No other factor (age, serum drug level, concomitant immunosuppressive medication, time since transplantation, underlying disease) was found to have an influence on sensitization or allergy prevalence (logistic regression).. Our results suggest that post-transplant immunosuppression with tacrolimus is associated with an increased occurrence of IgE-mediated sensitization and probably manifestation of allergic disease, which has to be treated specifically despite immunosuppressive therapy.

Topics: Adolescent; Adult; Cross-Sectional Studies; Cyclosporine; Eosinophilia; Humans; Hypersensitivity; Immunoglobulin E; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Multivariate Analysis; Sensitivity and Specificity; Skin Tests; Tacrolimus; Young Adult

To describe the clinical and laboratory profile, natural course, treatment outcome, and risk factors of posttransplant esophageal and nonesophageal eosinophilic gastrointestinal disorders (EGIDs).. All children (aged <18 years) who underwent liver transplantation, between 2011 and 2019, in a single transplant center with a follow-up period of 1 year or more posttransplant and with a history of posttransplant endoscopic evaluation were included in this study.. During the study period, 89 children met the inclusion criteria. Patients were followed for a median of 8.0 years. A total of 39 (44%) patients were diagnosed with EGID after transplantation. Of these, 29 (33%) had eosinophilic esophagitis (EoE), and 10 (11%) had eosinophilic gastritis, gastroenteritis or enterocolitis. In comparison with the non-EGID group, patients with EGID were younger at transplant (P ≤ 0.0001), transplanted more frequently due to biliary atresia (P ≤ 0.0001), and had higher rates of pretransplant allergy (P = 0.019). In the posttransplant period, they had higher rates of mammalian Target of Rapamycin inhibitor use (P = 0.006), Epstein-Barr virus viremia (P = 0.03), post-transplant lymphoproliferative disease (P = 0.005), and allergen sensitization (P ≤ 0.0001). In regression analysis, young age at transplant, age at diagnosis, pretransplant atopic dermatitis, and post-transplant lymphoproliferative disease were associated with an increased risk of EGID or EoE. Laboratory abnormalities such as anemia (P = 0.007), thrombocytosis (P = 0.012), and hypoalbuminemia (P = 0.031) were more commonly observed in the eosinophilic gastritis, gastroenteritis or enterocolitis group than in the EoE group. Following treatment, most patients had symptomatic resolution at 3 months and histologic resolution at 6 months postdiagnosis. Among the patients who had 5 years of follow-up, none recurred.. EGID is a common posttransplant diagnosis, which seems to affect patients who are transplanted earlier and who have pretransplant atopy. Posttransplant EGID is responsive to treatment, but as histologic remission occurs after symptomatic resolution, the decision to perform control endoscopy should be delayed.

Topics: Age Factors; Anti-Allergic Agents; Biliary Atresia; Budesonide; Child; Child, Preschool; Cholestasis, Intrahepatic; Dermatitis, Atopic; Disease Progression; Drug Tapering; Enteritis; Enterocolitis; Eosinophilia; Eosinophilic Esophagitis; Epstein-Barr Virus Infections; Female; Follow-Up Studies; Gastritis; Glucocorticoids; Graft Rejection; Humans; Hypersensitivity; Immunosuppressive Agents; Infant; Ketotifen; Liver Failure, Acute; Liver Transplantation; Lymphoproliferative Disorders; Male; Postoperative Complications; Prevalence; Retrospective Studies; Risk Factors; Tacrolimus; TOR Serine-Threonine Kinases; Treatment Outcome; Viremia

Eosinophils are a common clinical feature associated with chronic allergic diseases, and elemental diets, systemic steroids, anti-IL-5 and anti-IL-13 treatment have shown some therapeutic promise. Herein, we present evidence that pre- and post-intraperitoneal administration of tacrolimus (FK506) is very effective in reducing CCR3/Siglec-F

Topics: Allergens; Animals; Apoptosis; Aspergillosis; Aspergillus; Asthma; Calcium-Binding Proteins; Enteritis; Eosinophilia; Eosinophils; Fibrosis; Gastritis; Humans; Hypersensitivity; Immunosuppressive Agents; Interleukin-13; Interleukin-5; Lung; Mice; Mice, Inbred BALB C; Mice, Transgenic; Muscle Proteins; Respiratory Mucosa; Tacrolimus

Allergies are frequently implicated in ophthalmologic practice. These typically benign allergies can be potentially severe for the ocular surface and have an impact in everyday life. We relate, through a case of keratoconjunctivitis involving 2 types of hypersensitivity, the various triggers and therapeutic choices to allow a more effective treatment.

Topics: Adult; Allergens; Animals; Azithromycin; Blepharitis; Cats; Dermatitis, Atopic; Desensitization, Immunologic; Dogs; Drug Therapy, Combination; Eosinophilia; Histamine Antagonists; Humans; Hypersensitivity, Immediate; Immunoglobulin E; Intradermal Tests; Keratoconjunctivitis; Lubricant Eye Drops; Male; Pyroglyphidae; Rhinitis, Allergic, Seasonal; Tacrolimus

Wells syndrome (WS) or eosinophilic cellulitis is a rare, idiopathic, inflammatory dermatosis. The typical clinical presentation is urticarial plaque without preferential location that usually heals without scarring. We present a 62-year-old man with history of lung cancer that had undergone a right superior lobectomy 12 months previously. The patient had a relapsing dermatosis beginning about 6 months before the diagnosis of the lung cancer, characterised by pruritic, erythematous plaques located on the trunk and arms. These lesions spontaneously resolved within a few weeks without scarring. A skin biopsy revealed findings compatible with WS. Several diseases have been associated with WS. These include haematological diseases, fungal, parasitic and viral infections, drug reactions and rarely non-haematological malignancies. We present a case of this rare syndrome in a patient with history of lung cancer that we believe acted as a triggering event. To our knowledge, this is the second case reporting this association.

Topics: Administration, Topical; Biopsy; Cellulitis; Clobetasol; Dermatologic Agents; Eosinophilia; Humans; Loratadine; Lung Neoplasms; Male; Middle Aged; Recurrence; Skin Diseases; Tacrolimus; Treatment Outcome

An infant boy with steroid-resistant nephrotic syndrome (idiopathic membranous glomerulonephropathy) achieved remission with ciclosporin but developed eosinophilia and high IgE levels (max 19 000  iU/mL). Conversion to tacrolimus resulted in chronic diarrhoea (eosinophilic gastroenteritis), muscle weakness, polyserositis and failure-to-thrive. In contrast, a trial without tacrolimus resulted in a ciclosporin-responsive relapse, therapy-resistant focal seizures with generalised spikes, worsening muscle weakness and diarrhoea. The patient was weaned off of ciclosporin and completely normalised. In vitro testing demonstrated decreased viability of the patient's cells when incubated with calcineurin inhibitors (ciclosporin, 70%; tacrolimus, 80% compared to control cells), supporting their role in this adverse drug reaction.

Topics: Cell Survival; Cyclosporine; Deprescriptions; Drug Substitution; Enteritis; Eosinophilia; Failure to Thrive; Gastritis; Gingival Hyperplasia; Glomerulonephritis, Membranous; Humans; Hypertrichosis; Immunosuppressive Agents; In Vitro Techniques; Infant; Kidney Glomerulus; Male; Microscopy, Electron; Muscle Weakness; Seizures; Serositis; Tacrolimus; Vasculitis

Topics: Anti-Inflammatory Agents; Calcineurin Inhibitors; Cellulitis; Eosinophilia; Humans; Male; Middle Aged; Prednisolone; Recurrence; Tacrolimus

Post-TAFA is an uncommon but serious complication of organ transplantation. This study aimed to compare the incidence of FA in CsA and tacrolimus-treated children following OLT and identify risk factors. The medical charts of all patients who underwent OLT at our institution were reviewed. Between 1985 and 2010, 218 OLTs were performed on 188 pediatric recipients, of which 154 were included in the study. Three patients (3%) of the 102 receiving CsA developed FA, compared with nine (17%) in the 52 tacrolimus-treated patients, the latter exceeding general population reported FA prevalence (RR 5.88; 95% CI: 1.66-20.81). All TAFA cases underwent transplantation before the age of three with an incidence of 29% (9/31) in the tacrolimus-treated children in comparison with 7% (3/41) in the CsA group (RR 3.97; 95% CI: 1.17-13.45). Eosinophilia was present in 81% of children receiving tacrolimus compared with 54% in the CsA group (p = 0.002). We observed a statistically significant increase incidence of FA in tacrolimus-treated children following an OLT and those under the age of three are particularly vulnerable. The underlying process is still unknown and probably multifactorial.

Topics: Age Factors; Child; Child, Preschool; Cyclosporine; Eosinophilia; Female; Food Hypersensitivity; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Incidence; Infant; Liver Failure; Liver Transplantation; Male; Retrospective Studies; Risk Factors; Tacrolimus; Treatment Outcome

We conducted a study to clarify the incidence, clinical course, and risk factors of de novo allergies after liver transplantation. Ninety-three patients who had been followed longer than one yr and who had no previous allergy history were included. Forty-two patients (45.2%) developed de novo allergy. Of them, food allergy developed in 35 (37.6%). Respiratory allergy was observed in three (3.2%), and a patient (1.1%) had drug allergy. Fifty-two (55.9%) of the 93 patients developed eosinophilia. The median age of patients with de novo allergy was 15 months (IR 11.3-20 months). De novo allergy developed five months after liver transplantation (IR 2.3-9.5 months) and lasted for 16 months (IR 8-34.5 months). Younger age at liver transplantation displayed statistically significant differences in development of allergy between allergy and non-allergy groups. Twenty-nine (69.0%) patients improved from allergy during the follow-up period. No patient with de novo gastrointestinal allergy progressed to any respiratory allergy such as asthma. Older age at transplantation, EBV non-risk, and CMV non-risk had statistical significance in allergy improvement. Younger age at transplant predisposes to the development of allergy, while improvement of allergy is achieved more in older age.

Topics: Age Factors; Child, Preschool; Drug Hypersensitivity; Eosinophilia; Follow-Up Studies; Food Hypersensitivity; Humans; Hypersensitivity; Immunosuppressive Agents; Incidence; Infant; Liver Failure; Liver Transplantation; Proportional Hazards Models; Respiratory Hypersensitivity; Tacrolimus; Time Factors

Eosinophilic pustular folliculitis (EPF), first described by Ofuji et al. in 1970, is a rare dermatosis characterized by pruritic papules and pustules on circinate erythematous plaques with eosinophilic infiltration in and around the hair follicle.. We report three cases of EPF that showed no macroscopic pustules during the total observation period. Histopathological examination revealed eosinophilic infiltration in and around the hair follicle in the lower dermis and subcutis.. EPF consists of clinical variants, one of which lacks obvious pustules.

Topics: Adult; Dermatologic Agents; Eosinophilia; Female; Folliculitis; Humans; Indomethacin; Middle Aged; Skin Diseases, Vesiculobullous; Tacrolimus; Treatment Outcome

Classic eosinophilic pustular folliculitis (EPF), otherwise known as Ofugi disease, is a rare condition commonly treated with topical glucocorticosteroids. If this fails, oral indomethacin is frequently the next line. Because the condition is recurrent, the use of long term steroids may cause side effects such as skin atrophy, hypertrichosis, and dyspigmentation. Topical tacrolimus is an immunosuppressant that is generally used as a steroid-sparing agent in atopic dermatitis. We report a case of classic EPF, which was recurrent over 5 years that had failed topical glucocorticosteroids but was successfully treated with topical tacrolimus 0.1 percent ointment.

Topics: Eosinophilia; Female; Folliculitis; Glucocorticoids; Humans; Immunosuppressive Agents; Indomethacin; Middle Aged; Ointments; Skin Diseases, Vesiculobullous; Tacrolimus; Treatment Outcome

Topics: Administration, Topical; Eosinophilia; Folliculitis; Humans; Immunosuppressive Agents; Infant; Male; Skin Diseases, Vesiculobullous; Tacrolimus; Treatment Outcome

Churg-Strauss syndrome (CSS), which is characterized by systemic small-vessel vasculitis of unknown etiology, is associated with a history of asthma. Although reports of CSS occurring in children are limited, effective treatment of pediatric patients with severe CSS remains challenging. A 10-year-old Japanese boy with a 6-month history of asthma treated with a leukotriene modifier, pranlukast, developed high fever, pleural infiltration, and pericarditis that were associated with marked hypereosinophilia (10,350 eosinophils/µl). Owing to his persistent high fever, mononeuritis multiplex, and severe abdominal pain that was refractory to prednisolone, his general condition progressively deteriorated thereafter. Although intravenous high-dose immunoglobulin administration was transiently effective for mononeuritis multiplex, the recurrent high fever and severe abdominal pain remained refractory. An endoscopic study revealed ulcerative lesions of the total colon. In this context, we treated the patient with an aggressive multidrug immunosuppressive regimen consisting of a high-dose methylprednisolone pulse plus short-course intravenous cyclophosphamide pulse therapy, followed by oral tacrolimus combined with prednisolone. After the rescue multidrug treatment, his severe clinical signs dramatically subsided within a short time, and the concomitantly administered prednisolone was successfully tapered without flare. At present, 12 months after the presentation, he is free from CSS signs or therapy-related toxicity except for an occasional mild asthma attack. Although further close observation should be needed to draw a long-term outcome in this patient, we believe that aggressive multidrug immunosuppressive treatment should be considered as an alternative rescue treatment in selected patients with severe CSS, even with pediatric-onset disease, that is refractory to prednisolone.

Topics: Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Child; Chromones; Churg-Strauss Syndrome; Cyclophosphamide; Drug Resistance; Drug Resistance, Multiple; Eosinophilia; Humans; Immunosuppressive Agents; Japan; Methylprednisolone; Pericarditis; Pleura; Prednisolone; Tacrolimus; Ulcer

Topics: Aged; Asthma; Blood Vessels; Churg-Strauss Syndrome; Comorbidity; Eosinophilia; Female; Humans; Immunosuppressive Agents; Myasthenia Gravis; Osteoporosis; Prednisolone; Skin; Tacrolimus; Treatment Outcome

Eosinophilic pustular folliculitis is a rare dermatosis. Recently, in addition to oral indomethacin, other treatments have been applied for eosinophilic pustular folliculitis. The aim of this study was to assess the effectiveness of various therapies encompassing conventional to newly applied drugs for eosinophilic pustular folliculitis. Twenty patients with eosinophilic pustular folliculitis seen in our department were investigated. The effectiveness of each treatment was assessed by a severity score index. Eleven patients were treated with oral indomethacin, and the severity scores of all patients were decreased after the treatment. Oral cyclosporine was markedly effective in all 11 patients treated, and topical tacrolimus ointment alleviated eosinophilic pustular folliculitis in 3 of 7 with one patient showing a remarkable reduction in the severity score. In addition to indomethacin or other oral non-steroidal anti-inflammatory drugs, oral cyclosporine and topical tacrolimus may be beneficial choices when patients have been resistant to previous treatments.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal; Cyclosporine; Eosinophilia; Female; Folliculitis; Humans; Immunosuppressive Agents; Indomethacin; Male; Middle Aged; Tacrolimus; Treatment Outcome

A 72-year-old man presented with a 1-month history of a rash. The eruption had previously been successfully treated with oral corticosteroids (prednisolone 30 mg/day) and antihistamines on two previous occasions, but recurred several days after stopping treatment. On examination, multiple, indurated, round to annular erythematous plaques were found on the trunk and limbs. Histological examination revealed interstitial oedema, a dense infiltrate of eosinophils in the dermis, and flame figure formation. These results led us to the diagnosis of eosinophilic cellulitis. Treatment with oral corticosteroids (prednisolone 15 mg/day) was unsuccessful. Four weeks after the start of oral tacrolimus 1 mg/day, the eruption completely resolved.

Topics: Administration, Oral; Aged; Cellulitis; Eosinophilia; Humans; Immunosuppressive Agents; Male; Recurrence; Tacrolimus; Treatment Outcome

Topics: Adult; Eosinophilia; Folliculitis; Humans; Immunosuppressive Agents; Male; Ointments; Tacrolimus; Treatment Outcome

Topics: Administration, Cutaneous; Antiretroviral Therapy, Highly Active; Eosinophilia; Folliculitis; HIV Infections; Humans; Immunosuppressive Agents; Tacrolimus; Uganda

De novo development of food allergy is an infrequent but potentially serious complication of transplantation. An increased prevalence of food allergy noted specifically in children receiving tacrolimus immunosuppression supports the hypothesis that selective suppression of Th1 lymphocytes by the IL-2 inhibitor immunosuppressants CsA, and the more potent drug, tacrolimus , promotes Th2 lymphocytes and an allergic immune response. This study was undertaken to characterize the IgE-mediated immune response, in CsA and tacrolimus-treated, post-OLT children. Thirty children and adolescents aged 1.9-21 yr, mean: 10.6 yr, (6.4 yr post-tx.) were studied. Immunosuppression-CsA: 10 patients, tacrolimus; 20 patients. Blood eosinophils, total IgE levels and specific IgE antibodies (Immulite 2000 Allergy; Diagnostic Products Corp., Los Angeles, CA, USA) to a panel of food and inhaled allergens were measured and correlated with clinical symptoms of allergy. Eosinophilia (>500/mm(3)) range: 599-3125, mean: 1294, was present in 10/20 of patients treated with tacrolimus and 1/10 treated with CsA. IgE levels were elevated in eight of these 10 tacrolimus-treated patients and in two CsA patients ; five were <3 yr of age and IgE levels ranged from 54 to 111 IU/mL (mean: 83), normal for age <45 IU/mL and five were > or =9 yr and IgE levels ranged from 134 to 1606 IU/mL (mean: 557), normal for age <87 IU/mL. Specific IgE levels to a wide panel of food allergens were positive in five tacrolimus-treated patients and to both food and inhaled allergens in three patients (two tacrolimus-treated, one CsA). Four children (tacrolimus-treated) had symptoms of food allergy . None had a family history of allergy. Eosinophilia is present in up to 50% of children and adolescents receiving tacrolimus immunosuppression. The majority of these patients also have elevated levels of total and specific (mainly to food allergens) IgE antibodies. Most patients are asymptomatic and do not manifest food allergy or asthma.

Topics: Adolescent; Adult; Child; Child, Preschool; Cyclosporine; Eosinophilia; Female; Food Hypersensitivity; Humans; Immunoglobulin E; Immunosuppressive Agents; Infant; Liver Function Tests; Liver Transplantation; Male; Tacrolimus

Tacrolimus is a macrolide agent that is now the primary immunosuppressant used in prevention of graft rejection in transplant recipients. It has been found to be superior to cyclosporine (CSA) for rescue therapy as well as for earlier weaning of steroids. Both tacrolimus and CSA share similar toxicity profiles; however, their gastrointestinal side effects have received little attention. We report three cases of eosinophilic colitis in liver transplant recipients, maintained on tacrolimus as immunosuppressive medication post-liver transplantation. These patients also had high serum immunoglobulin (Ig)E levels, eosinophilia and IgE-positive radioallergosorbent test for milk proteins. The colitis appeared to be mediated by food allergies. Each patient had symptomatic improvement following reduced immunosuppression and an appropriately restricted diet. We conclude that tacrolimus may play a role in the initiation of food allergies, leading to eosinophilic colitis. More studies are needed in a controlled setting to identify the prevalence of similar findings among other pediatric liver transplant recipients.

Topics: Child; Colitis; Eosinophilia; Food Hypersensitivity; Humans; Immunoglobulin E; Immunosuppressive Agents; Infant; Liver Transplantation; Male; Tacrolimus

Sterile eosinophilic folliculitis, a clinical entity first described by Ofuji in 1970, is a rather rare skin disorder, in particular in the non-Asian population. We report the first case of eosinophilic folliculitis associated with toxocariasis in a Caucasian patient. Topical and systemic anti-inflammatory and antiphlogistic therapy along with systemic antihelminthic treatment resulted in complete remission of the skin lesions. In addition, there was a marked decrease of antibodies to Toxocara antigens in the patient's serum following antihelminthic therapy. Given that (I) some cases of eosinophilic folliculitis have been reported which were associated with infestation with metazoan parasites; (2) infestations with the roundworm Toxocara canis are known to induce eosinophilic reactions in some tissues; and (3) therapy-induced remission of eosinophilic folliculitis was accompanied by a decrease of Toxocara-directed antibodies in the patient's serum, we propose that there is an aetiopathogenic link between toxocariasis and eosinophilic folliculitis in this patient.

Topics: Albendazole; Animals; Anthelmintics; Eosinophilia; Female; Folliculitis; Humans; Immunosuppressive Agents; Middle Aged; Pruritus; Tacrolimus; Toxocara canis; Toxocariasis; White People

There is a lack of studies on the effect of tacrolimus on eosinophils and related molecules including eotaxin, CCR3, RANTES and interleukin (IL)-5.. To investigate the effects of tacrolimus on in vivo eosinophil counts and on the related molecules eotaxin, CCR3, RANTES and IL-5 in patients with atopic dermatitis (AD).. Lesional skin specimens and sera were obtained from 15 patients with AD and from 15 normal controls. For 8 weeks, the patients with AD applied 0.03% tacrolimus ointment to all affected areas twice daily. Blood sampling and skin biopsies were then repeated. We evaluated serum eotaxin and IL-5 levels, and tissue eotaxin, CCR3, RANTES and IL-5 levels. Additionally, tissue levels of eotaxin and CCR3 mRNA were measured.. After treatment with topical tacrolimus twice daily for 8 weeks, significant decreases were found in serum IL-5 levels, immunoreactive cell counts of eotaxin, IL-5, CCR3 and RANTES in AD skin, and tissue eosinophil counts. However, the change in the serum eosinophil count was not statistically significant, and mRNA levels of eotaxin and CCR3 were not decreased significantly after treatment.. Topical tacrolimus reduces the number of eosinophils in tissue and suppresses the expression of eotaxin, CCR3, RANTES and IL-5 related to proliferation, recruitment, activation and survival of eosinophils.

Topics: Adolescent; Adult; Biomarkers; Case-Control Studies; Chemokine CCL11; Chemokine CCL5; Chemokines, CC; Child; Child, Preschool; Dermatitis, Atopic; Eosinophilia; Female; Humans; Immunohistochemistry; Immunosuppressive Agents; Interleukin-5; Korea; Leukocyte Count; Male; Ointments; Receptors, CCR3; Receptors, Chemokine; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Skin; Tacrolimus

Topics: Administration, Topical; Adult; Eosinophilia; Female; Folliculitis; HIV Infections; Humans; Immunosuppressive Agents; Male; Middle Aged; Tacrolimus; Treatment Outcome

Topics: Child; Drug Resistance; Eosinophilia; Epstein-Barr Virus Infections; Herpesviridae Infections; Herpesvirus 6, Human; Humans; Immunosuppressive Agents; Intestines; Male; Syndrome; Tacrolimus

We present two cases of Eosinophilic pustular folliclulitis (EPF) who were successfully treated with topical tacrolimus. Indomethacin is the most frequently used agent for the treatment of EPF, however, tacrolimus ointment may become the treatment of choice for patients with EPF.

Topics: Adolescent; Adult; Eosinophilia; Female; Folliculitis; Humans; Immunosuppressive Agents; Tacrolimus; Treatment Outcome

Topics: Adult; Eosinophilia; Female; Folliculitis; Humans; Immunosuppressive Agents; Tacrolimus

We describe a patient with eosinophilic pustular folliculitis who partially responded to oral indomethacin, but intermittently experienced new eosinophilic pustular folliculitis lesions. Treatment with tacrolimus ointment 0.1% resulted in the rapid improvement of each recurred lesion and allowed withdrawal of indomethacin. To our knowledge, this is the first report of the use of topical tacrolimus in the treatment of eosinophilic pustular folliculitis.

Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Drug Therapy, Combination; Eosinophilia; Folliculitis; Humans; Immunosuppressive Agents; Indomethacin; Male; Middle Aged; Ointments; Recurrence; Tacrolimus; Treatment Outcome

Helper T cells are involved in the pathophysiologic condition of asthma, so modulation of cytokine production may be effective therapy.. We aimed to selectively control the synthesis of IL-5 by helper T cells and tested in vivo effects using a murine asthma model.. The effect of dexamethasone, FK506, cyclosporin A, and nonactin (a macrolide compound produced by Streptomyces griseus) on cytokine production by allergen-specific T-cell clones was determined. The effect of these agents and an anti-IL-5 neutralizing antibody on airway eosinophilic inflammation was investigated in a murine asthma model.. Dexamethasone, FK506, and cyclosporin A suppressed the production of IL-2, IL-4, and IL-5 by human helper T cells, which shows a similar concentration-response relationship in each case. Cyclosporin A and dexamethasone inhibited airway eosinophilia in vivo. Nonactin suppressed IL-5 synthesis but not IL-2 or IL-4 synthesis, and it also significantly suppressed airway eosinophilia.. Nonactin only suppressed IL-5 synthesis and was as effective against eosinophilia as cyclosporin A and dexa-methasone, which indicates that IL-5 is a reasonable therapeutic target in allergic disorders that are accompanied by eosinophilic inflammation.

Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Asthma; Clone Cells; Cyclosporine; Dexamethasone; Disease Models, Animal; Dose-Response Relationship, Drug; Eosinophilia; Humans; Immunosuppressive Agents; Inflammation; Interleukin-2; Interleukin-4; Interleukin-5; Macrolides; Mice; Mice, Inbred BALB C; T-Lymphocytes; T-Lymphocytes, Helper-Inducer; Tacrolimus

Topics: Adult; Eosinophilia; Folliculitis; Humans; Immunosuppressive Agents; Male; Ointments; Skin; Tacrolimus

Pneumocystis carinii pneumonia (PcP) in immunocompromised patients is suggested if the following symptoms develop: dyspnea, fever, and interstitial infiltrates on chest x-ray. We observed a significant blood eosinophilia in kidney recipients with PcP under immunosuppressive treatment with tacrolimus.. Blood eosinophil counts of kidney recipients under immunosuppression with tacrolimus suffering from PcP were compared to eosinophil counts of patients without evidence of PcP and to patients showing PcP under immunosuppression with cyclosporine.. PcP-positive patients treated with tacrolimus showed a significantly higher blood eosinophil count compared to PcP-positive patients treated with cyclosporine (P=0.01), and to patients under immunosuppression with tacrolimus without PcP, respectively (P=0.006). Eosinophilia preceded the time of a definitive PcP diagnosis by bronchoalveolar lavage and decreased after successful treatment.. An increasing blood eosinophil count can be an indicator of P. carinii pneumonia in patients under immunosuppressive therapy with tacrolimus.

Topics: Adult; Aged; Azathioprine; Cyclosporine; Drug Therapy, Combination; Eosinophilia; Female; Humans; Immunosuppressive Agents; Kidney Transplantation; Leukocyte Count; Male; Middle Aged; Pneumonia, Pneumocystis; Prednisolone; Retrospective Studies; Tacrolimus

1. The effect of the immunosuppressive agent, FK-506, an allergen-induced airways eosinophilia and bronchial hyperreactivity (BHR) in hyper IgE mice (BP2 selection) was investigated. 2. Administration of FK-506 at 2 mg kg-1 s.c., 1 h before and 5 h after the first four ovalbumin challenges, reduced the recruitment of eosinophils into the bronchoalveolar lavage fluid (BALF) from 1.36 +/- 0.22 x 10(5) to 0.53 +/- 0.24 x 10(5) cells ml-1 (n = 5-6, P < 0.05; 60% inhibition), inhibited by 80% BHR in response to i.v. 5-HT and practically suppressed BHR in response to inhaled methacholine. 3. The antigen-induced interleukin (IL)-5 formation in the BALF and serum was inhibited by FK-506 by 75% in both instances. 4. FK-506 failed to modify the bronchoconstriction in BP2 mice, suggesting that different mechanisms are involved in acute bronchoconstriction and BHR. 5. The increased number of CD4+, CD8+, CD3+ T lymphocytes in the BALF to antigen-challenged mice was unaffected by FK-506. 6. These findings indicate that antigen-induced in vivo IL-5 release and eosinophil, but not T-cell, infiltration into the bronchial lumen of sensitized BP2 mice are targets for the anti-allergic activities of FK-506.

Topics: Animals; Bronchial Hyperreactivity; Bronchoalveolar Lavage Fluid; Eosinophilia; Fluorescent Antibody Technique, Indirect; Immunoenzyme Techniques; Immunosuppressive Agents; Interleukin-5; Lymphocyte Count; Male; Mice; Mice, Inbred Strains; Ovalbumin; Respiratory Function Tests; T-Lymphocytes; Tacrolimus

Topics: Eosinophilia; Female; Humans; Liver Transplantation; Lung; Middle Aged; Pneumonia; Radiography; Tacrolimus