immunoglobulin (Bivigam)

Management of Refractory Eosinophilic Fasciitis Using Biologic Therapies, Janus Kinase Inhibitors, and Intravenous Immunoglobulin: A Systematic Review.

Mitwalli Mohammed M, Waked Jihad Abou Ali JAA, Sood Siddhartha S, Abduelmula Abrahim A et al.

De Novo Proliferative Glomerulonephritis With Monoclonal Immunoglobulin Deposits (PGNMID) in a Renal Transplant Recipient.

Murugesan Ram Prabahar RP, Sivanandam Sathiyan S, Jayam Jayanivash J, Kurian Anila A AA

Proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) represents a distinct glomerular pathology, classified under monoclonal gammopathy of renal significance (MGRS). In renal transplant, PGNMID usually develops as a recurrent disease, but can rarely arise de novo. Recurrence is relatively common, typically appearing within five to six months post-transplant, and is linked to poor graft outcomes. De novo PGNMID is exceedingly rare, with few reported in the literature. It generally presents in the late post-transplant period, with a more indolent clinical course and a variable response to immunotherapy. This case report is of a 50-year-old patient who had diabetic nephropathy as his native kidney disease. This report documents a unique instance of de novo PGNMID, occurring three years post-transplantation with persistent allograft dysfunction. The transplant kidney biopsy showed mesangial hypercellularity with immunoglobulin (Ig)G and kappa light chain deposition by immunofluorescence; however, electron microscopy was non-contributory due to the absence of viable glomeruli. Despite extensive evaluation, we could not identify any clone contributing to the MGRS in the bone marrow, nor could we identify any other evidence of lymphoproliferative disease on positron emission tomography-computed tomography (PET-CT). We managed the patient with empirical clone-directed therapy against a likely B-cell clone using Rituximab. During rituximab therapy, the patient developed E. coli urosepsis, which was managed successfully. At the last follow-up, graft function remained stable without progression, although the duration of follow-up is limited.

Allergenic protein behavior, parvalbumin (PA) contained in skipjack tuna (Katsuwonus pelamis) during the fish sauce processing stage.

Amalia Ulfah U, Romadhon Romadhon R, Purnamayati Lukita L

Parvalbumin (PA) is a major muscle allergen in fish capable of triggering immunoglobulin E-mediated hypersensitivity reactions in fish-allergic individuals. This study investigated the degradation and allergenic behavior of PA in skipjack tuna (Katsuwonus pelamis) sauce during a 60-day fermentation process, sampled at 20-day intervals. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting were used to monitor PA profiles and immunoglobulin G (IgG)-binding ability, which revealed a thin, undetectable band of PA and low IgG-binding ability by immunoblotting with the progress of fish sauce manufacturing. Additionally, because skipjack tuna belongs to the Scombridae family, histamine levels, pH, total acidity, and total soluble peptides were analyzed to ensure food safety and monitor proteolysis. The results demonstrated that PA bands became progressively thinner and undetectable by day 60, which strongly correlated with a marked decrease in IgG-binding ability. Fermentation also triggered significant peptide solubilization, while histamine content showed a strong correlation with changes in pH and total acidity. These findings demonstrate that traditional fish sauce processing effectively degrades the allergenic protein PA, highlighting fermentation as a viable method to reduce allergenicity in scombroid fish products while maintaining standard quality markers.

The Basophil Activation Test in Allergy Diagnostics: Clinical Applications, Methodological Challenges, and Proposed Clinical Frameworks.

Izmailovich Marina M, Kabyldina Aizhan A, Seilkhan Zamira Z, Zhussip Aruzhan A et al.

The basophil activation test (BAT) is a modern in vitro functional assay used for the diagnosis of immunoglobulin E-mediated allergic reactions. The method is based on flow cytometric assessment of activation marker expression on peripheral blood basophils after stimulation with specific allergens. BAT has gained increasing clinical relevance in allergology, particularly in patients with anaphylaxis risk, polysensitization, drug hypersensitivity, and inconclusive skin or serological test results. This narrative review summarizes current evidence on the diagnostic performance and clinical applications of BAT in food allergy, drug hypersensitivity, Hymenoptera venom allergy, latex sensitization, and allergen immunotherapy monitoring. The review discusses the immunological mechanisms of basophil activation, the role of CD63 and CD203c, methodological aspects of the assay, sensitivity and specificity data, and advantages and limitations compared with conventional diagnostic approaches. Particular attention is given to protocol standardization, interpretation criteria, and the problem of non-responder patients. Current evidence indicates that BAT demonstrates high specificity and provides functional assessment of clinically relevant allergic reactions. In addition, this review proposes practical clinical frameworks for integrating BAT into allergy diagnostic pathways and for managing inconclusive or non-responder BAT results. Further standardization, multiplex formats, and automated analytical approaches may expand its role in personalized allergy diagnostics.