1.Chronic Food Antigen-specific IgG-mediated Hypersensitivity Reaction as A Risk Factor for Adolescent Depressive Disorder.
Ran TAO ; Zhicheng FU ; Lijun XIAO
Genomics, Proteomics & Bioinformatics 2019;17(2):183-189
		                        		
		                        			
		                        			Major depressive disorder (MDD) is the most common nonfatal disease burden worldwide. Systemic chronic low-grade inflammation has been reported to be associated with MDD progression by affecting monoaminergic and glutamatergic neurotransmission. However, whether various proinflammatory cytokines are abnormally elevated before the first episode of depression is still largely unclear. Here, we evaluated 184 adolescent patients who were experiencing their first episode of depressive disorder, and the same number of healthy individuals was included as controls. We tested the serum levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), IgE, 14 different types of food antigen-specific IgG, histamine, homocysteine, S100 calcium-binding protein B, and diamine oxidase. We were not able to find any significant differences in the serum levels of hs-CRP or TNF-α between the two groups. However, the histamine level of the patients (12.35 μM) was significantly higher than that of the controls (9.73 μM, P < 0.001, Mann-Whitney U test). Moreover, significantly higher serum food antigen-specific IgG positive rates were also found in the patient group. Furthermore, over 80% of patients exhibited prolonged food intolerance with elevated levels of serum histamine, leading to hyperpermeability of the blood-brain barrier, which has previously been implicated in the pathogenesis of MDD. Hence, prolonged high levels of serum histamine could be a risk factor for depressive disorders, and antihistamine release might represent a novel therapeutic strategy for depression treatment.
		                        		
		                        		
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Biomarkers
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			C-Reactive Protein
		                        			;
		                        		
		                        			Chronic Disease
		                        			;
		                        		
		                        			Cytokines
		                        			;
		                        		
		                        			Depressive Disorder, Major
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			epidemiology
		                        			;
		                        		
		                        			etiology
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Food Hypersensitivity
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			complications
		                        			;
		                        		
		                        			Histamine
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Homocysteine
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Immunoglobulin E
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Immunoglobulin G
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Inflammation Mediators
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Risk Factors
		                        			;
		                        		
		                        			S100 Calcium Binding Protein beta Subunit
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Young Adult
		                        			
		                        		
		                        	
2.Allergenic Characterization of 27-kDa Glycoprotein, a Novel Heat Stable Allergen, from the Pupa of Silkworm, Bombyx mori.
Kyoung Yong JEONG ; Mina SON ; June Yong LEE ; Kyung Hee PARK ; Jae Hyun LEE ; Jung Won PARK
Journal of Korean Medical Science 2016;31(1):18-24
		                        		
		                        			
		                        			Boiled silkworm pupa is a traditional food in Asia, and patients with silkworm pupa food allergy are common in these regions. Still now only one allergen from silkworm, arginine kinase, has been identified. The purpose of this study was to identify novel food allergens in silkworm pupa by analyzing a protein extract after heat treatment. Heat treated extracts were examined by proteomic analysis. A 27-kDa glycoprotein was identified, expressed in Escherichia coli, and purified. IgE reactivity of the recombinant protein was investigated by ELISA. High molecular weight proteins (above 100 kDa) elicited increased IgE binding after heat treatment compared to that before heat treatment. The molecular identities of these proteins, however, could not be determined. IgE reactivity toward a 27-kDa glycoprotein was also increased after heating the protein extract. The recombinant protein was recognized by IgE antibodies from allergic subjects (33.3%). Glycation or aggregation of protein by heating may create new IgE binding epitopes. Heat stable allergens are shown to be important in silkworm allergy. Sensitization to the 27-kDa glycoprotein from silkworm may contribute to elevation of IgE to silkworm.
		                        		
		                        		
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Allergens/*chemistry/*immunology
		                        			;
		                        		
		                        			Amino Acid Sequence
		                        			;
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Bombyx/*chemistry/genetics/growth & development/*immunology
		                        			;
		                        		
		                        			Epitopes/immunology
		                        			;
		                        		
		                        			Female
		                        			;
		                        		
		                        			Food Hypersensitivity/etiology
		                        			;
		                        		
		                        			Glycoproteins/*chemistry/genetics/*immunology
		                        			;
		                        		
		                        			Hot Temperature
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Immunoglobulin E/immunology
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Molecular Sequence Data
		                        			;
		                        		
		                        			Molecular Weight
		                        			;
		                        		
		                        			Proteomics
		                        			;
		                        		
		                        			Pupa/chemistry/immunology
		                        			;
		                        		
		                        			Recombinant Proteins/biosynthesis/chemistry/immunology
		                        			;
		                        		
		                        			Sequence Alignment
		                        			
		                        		
		                        	
3.Establishment of a rat model of oral food allergy.
Qing-Ling ZHU ; Feng LI ; Jun-Li WANG ; Jing-Qiu MA ; Xiao-Yang SHENG
Chinese Journal of Contemporary Pediatrics 2016;18(8):757-761
OBJECTIVETo establish a food allergy model in Brown Norway (BN) rats by gavage of ovalbumin (OVA) without any adjuvant, and to evaluate this model.
METHODSA total of 20 male BN rats aged 3 weeks were randomly divided into allergy group and control group (n=10 each). BN rats in the allergy group were given OVA 1 mg per day by gavage, and all the rats were treated for 41 days continuously. On day 42, the rats in the allergy group were given OVA 100 mg by gavage for challenge. The rats in the control group were given normal saline of the same volume by gavage. Differences in body length, body weight, and food intake were compared between the two groups on days 7, 14, 21, 28, 35, and 42. ELISA was used to measure the serum OVA-IgE level and plasma histamine level after challenge on day 42, and the changes in rats' appearance and fecal properties were observed. The model of food allergy was considered successful when the serum OVA-IgE level in the allergy group was no less than the mean serum OVA-IgE level + 3 standard deviation in the control group.
RESULTSThere were no significant differences in body length, body weight or food intake between the allergy and control groups at all time points (P>0.05). On day 21, the control group had a significantly higher food intake than the allergy group (P<0.05). On day 42 after challenge, the allergy group showed significantly higher serum OVA-IgE and plasma histamine levels than the control group (P<0.05). The sensitization rate (rate of successful modeling) was 90%. The fecal properties showed no significant differences between the two groups.
CONCLUSIONSOVA by gavage without any adjuvant can successfully establish the model of food allergy in BN rats and has a high success rate. Food allergy induced by OVA may reduce food intake within a short period of time, but no influence on rats' body length or body weight has been observed.
Animals ; Disease Models, Animal ; Food Hypersensitivity ; etiology ; immunology ; Histamine ; blood ; Immunoglobulin E ; blood ; Male ; Ovalbumin ; immunology ; Rats ; Rats, Inbred BN
4.Risk factors for recurrent wheezing in infants and young children suffering from dust mite allergy after their first wheezing.
Yan-Zhen YANG ; Meng-Yun CAI ; Bao-Zhong ZHANG ; Bing-Xin ZHOU ; Rou CHEN ; Run-Tao FANG
Chinese Journal of Contemporary Pediatrics 2016;18(12):1259-1263
OBJECTIVETo investigate the risk factors for recurrent wheezing in infants and young children suffering from dust mite allergy after their first wheezing.
METHODSA total of 1 236 infants and young children who experienced a first wheezing episode and were hospitalized between August 2014 and February 2015 were enrolled, among whom 387 were allergic to dust mites. These infants and young children were followed up to 1 year after discharge. A total of 67 infants and young children who experienced 3 or more recurrent wheezing episodes within 1 year were enrolled as the recurrent wheezing group, while 84 infants and young children who did not experience recurrent wheezing during follow-up were enrolled as the control group. Univariate analysis and multivariate logistic stepwise regression analysis were performed to investigate the risk factors for recurrent wheezing in these patients.
RESULTSThe univariate analysis showed that the age on admission, wheezing time before admission, Mycoplasma pneumoniae infection rate, and influenza virus infection rate were associated with recurrent wheezing. The multivariate logistic stepwise regression analysis showed that the older age on admission (OR=2.21, P=0.04) and Mycoplasma pneumoniae infection (OR=3.54, P=0.001) were independent risk factors for recurrent wheezing.
CONCLUSIONSInfants and young children who are allergic to dust mites, especially young children, have a significantly increased risk of recurrent wheezing if they are complicated by Mycoplasma pneumoniae infection during the first wheezing episode.
Animals ; Child, Preschool ; Female ; Humans ; Hypersensitivity ; complications ; Infant ; Logistic Models ; Male ; Pyroglyphidae ; immunology ; Recurrence ; Respiratory Sounds ; etiology ; Risk Factors
5.Positive allergens in children with different allergic diseases.
Chinese Journal of Contemporary Pediatrics 2015;17(9):912-917
OBJECTIVETo investigate the major allergens in children with different allergic diseases, and to provide theoretical evidence for the clinical prevention, diagnosis, and treatment of allergic diseases in children.
METHODSSkin prick test (SPT) was conducted to detect allergens in 1179 allergic children. According to clinical diagnoses, patients were categorized into six groups: atopic dermatitis (n=140), allergic gastroenteritis (n=37), allergic conjunctivitis (n=77), asthma (n=285), allergic rhinitis (n=301) and allergic co-morbidity (n=329) groups.
RESULTSOf the 1179 patients, 82.0% had positive SPT results; the most prevalent inhalant allergens were Dermatophagoides farinae (68.1%) and Dermatophagoides pteronyssinus (53.5%), while the most common food allergens were milk (5.0%) and eggs (4.8%). The proportions were 84.3% and 83.8% for patients under or equal to 3 years of age in the atopic dermatitis and allergic gastroenteritis groups, respectively. Patients over 4 years of age accounted for the majority of the other four groups. Food as major allergens were found in both atopic dermatitis and allergic gastroenteritis groups; eggs and Dermatophagoides farinae were the most common allergens for the former group, while eggs and milk for the latter group. Inhalant allergens were the major allergens in the allergic conjunctivitis, allergic rhinitis, asthma, and allergic co-morbidity groups, and the most prevalent allergens were Dermatophagoides farinae and Dermatophagoides pteronyssinus.
CONCLUSIONSThere are differences in the distribution of age and allergen types in children with different allergic diseases. Atopic dermatitis and allergic gastroenteritis are prevalent in infants and young children, and food allergens are more common. Patients in allergic conjunctivitis, allergic rhinitis, asthma, and allergic co-morbidity groups are mostly children over 4 years of age, and inhalant allergens are more common.
Adolescent ; Allergens ; immunology ; Child ; Child, Preschool ; Female ; Humans ; Hypersensitivity ; etiology ; Infant ; Male ; Skin Tests
6.Cow's milk challenges in gastrointestinal cow's milk allergic diseases.
Tang LUJING ; Zhao HONG ; Chen JIE
Chinese Journal of Pediatrics 2015;53(4):285-289
OBJECTIVETo understand the clinical features of gastrointestinal cow's milk allergy in children, and to assess the importance of cow's milk challenge.
METHODAn analysis was performed on the clinical manifestations and the challenge results of 50 children who received cow's milk challenges after admission to the department of gastroenterology, Children' s Hospital of Zhejiang University School of Medicine from January,2009 to December, 2012. The value of immunoglobulin E antibody was also analyzed among the 50 children, 25 cases were male and the other 25 were female. The youngest subject was 1. 6 months old, and the oldest was 20 months, most of the cases were younger than 6 months (36 cases).
RESULT(1) Diarrhea (27 cases, 54%) and hematochezia (25 cases, 50%) were the most common clinical features, vomiting, hematemesis and abdominal distention were rare. (2) Cow's milk challenges failed in 58% of the cases, 90% of whom showed delayed allergy. Diarrhea (19 cases, 73%) was the major later presentation, whereas the immediate hypersensitivity showed angio-edema, gastrointestinal symptom and rash. (3) The neutrophil count ((3.8 ± 2.8) x 10(9)/L vs. (2.5 ± 1.3) x 10(9)/L) was higher after challenge among children who failed the challenge. The change in the count of blood cell, neutrophil and platelet was studied, however, there were no statistical differences between the challenge-failed children and the passed ones. (4) Forty-seven cases had milk specific immunoglobulin E antibody test, and 5 showed positive results, 4 of whom were seen among the challenge-failed children.
CONCLUSIONDiarrhea and hematochezia was the most common clinical manifestation, and cow's milk protein induced proctocolitis was the most common disease in practice. It is important and necessary to perform cow's milk challenge.
Animals ; Female ; Gastrointestinal Diseases ; etiology ; Gastrointestinal Hemorrhage ; etiology ; Hematemesis ; etiology ; Humans ; Hypersensitivity, Immediate ; immunology ; Infant ; Infant, Newborn ; Male ; Milk ; Milk Hypersensitivity ; immunology ; Vomiting ; etiology
7.Experimental study on pseudoallergic reaction of Qingkailing injection.
Hong-Yu CUI ; Yan YI ; Chun-Ying LI ; Yu-Shi ZHANG ; Yong ZHAO ; Gui-Qin LI ; Ai-Hu LIANG ; Yun-Ting WANG
China Journal of Chinese Materia Medica 2014;39(3):511-514
		                        		
		                        			
		                        			Pseudoallergic reactions of Qingkailing injection (QKLI) was assessed by vascular hyperpermeability which were indicated by ear blue staining in ICR mice after single intravenous injection of QKLI mixed with Evans blue (EB) and skin blue spot formation in SD rats after intradermal injection of QKLI and intravenous injection of EB. In addition, QKLI-induced histamine, VEGF, TNF-alpha release was measured after ICR mice received the single dosing of QKLI iv. The mild vascular hyperpermeability characterized by ear blue staining could be observed in mice after intravenous injection of QKLI and EB. Intracutaneous injection of 50 micro L of test solution containing QKLI (25,50 microL) in rat back skin caused obvious local vascular hyperpermeability at the injection sites so as to result the larger diameters of blue spots than that in negative control group (P <0. 01). QKLI induced a significant increase of VEGF and a slight elevation of histamine in mice after intravenous administration, while TNF-alpha showed no change after QKLI iv. The results in this study indicated that both intravenous injection and intracutanous injection of QKLI could induce vascular hyperpemeability so as to cause pseudoallergic reaction in mice and rats. QKLI-induced pseudoallergic reaction may be associated with the release of histamine and VEGF.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Drug Hypersensitivity
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			etiology
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Drugs, Chinese Herbal
		                        			;
		                        		
		                        			administration & dosage
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Histamine
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Injections
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Mice
		                        			;
		                        		
		                        			Rats
		                        			;
		                        		
		                        			Skin
		                        			;
		                        		
		                        			drug effects
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Tumor Necrosis Factor-alpha
		                        			;
		                        		
		                        			blood
		                        			;
		                        		
		                        			Vascular Endothelial Growth Factor A
		                        			;
		                        		
		                        			blood
		                        			
		                        		
		                        	
8.Effects of epithelial cell injury of the lower respiratory tract in the pathogenesis of allergic responses in a rat model.
Wei-li CHU ; Ming CHU ; Yue-dan WANG ; Yan HU ; Can ZHAO ; Li SU ; Yan XIONG ; Tong-sheng YANG ; Ying-hong TAO ; Hai-chao LI
Chinese Medical Journal 2013;126(1):72-77
BACKGROUNDAsthma is a complex disease involving genetic and environment interactions. Atopy is a strong risk factor for asthma. The airway epithelium not only forms a physical barrier but also provides immune defense against harmful materials. To explore the effects of airway epithelium on asthma, we hypothesized that environmental injuries could act on bronchial epithelial cells and damage the physical barrier, which might facilitate allergens to stimulate immunoreactions and play an important role in the pathogenesis of asthma.
METHODSThirty eight-week-old male Wistar rats were randomly divided into five groups with six rats in each group: control group, asthma group, ovalbumin (OVA) + OVA group, lipopolysaccharide (LPS) group and LPS + OVA group. In the control group, 0.9% saline was injected intraperitoneally on day 1. Fourteen days later, the rats were exposed to aerosolized 0.9% saline. In the asthma group, the rats were sensitized with an injection of 10 mg of OVA, followed by an aerosolized 2% OVA challenge 14 days later. The OVA + OVA group was sensitized by an inhalation 2% OVA, 20 minutes a day, from day 1 to day 7, and then OVA challenged in the same way as the asthma group. In the LPS group, LPS (200 µl, 1 µg/µl) was given by airway on day 1 and day 3, with a simultaneous aerosol inhalation of 2% OVA for 20 minutes a day from day 1 to day 7. Fourteen days later, the rats were challenged with saline as in the control group. While in the LPS + OVA group, LPS (200 µl, 1 µg/µl) was given by airway on day 1 and day 3, with a simultaneous aerosol inhalation of 2% OVA for 20 minutes a day from day 1 to day 7. Fourteen days later, the rats were challenged with OVA as in the asthma group. The expression of interleukin (IL)-4, interferon-gamma (IFN-γ) and thymic stromal lymphopoietin (TSLP) in the lungs was detected by reverse transcription polymerase chain reaction (RT-PCR) and the pulmonary pathological changes were also observed. The level of IL-4, IFN-γ and IgE in plasma was detected by enzyme-linked immunosorbent assay (ELISA). Bronchoalveolar lavage fluid (BALF) was collected to conduct differential cell counts. Flow cytometry analysis was also used to count Th1 and Th2 cells.
RESULTSThe pathological changes in the LPS + OVA group were similar to the asthma group, while in other groups, the pathological changes were not obvious. The ratio of lymphocytes in BALF, IL-4/IFN-γ in plasma and the expression of the TSLP and IL-4 in the asthma and LPS + OVA groups were higher than in the control group and the OVA + OVA group (P < 0.05). The level of IgE was higher in the asthma, LPS and LPS + OVA groups than in the control group and the OVA + OVA group (P < 0.05). By flow cytometry analysis, the Th1/Th2 ratio was lower in the LPS + OVA and asthma groups than in other groups (P < 0.05).
CONCLUSIONSThe experiment results show that the injury to the bronchial epithelial layer may be the initial event of allergic responses. This finding implies that a rational approach to therapeutics would be to increase the resistance of the airways to environmental injuries rather than concentrating on suppressing inflammation.
Animals ; Bronchi ; pathology ; Cell Count ; Cytokines ; physiology ; Disease Models, Animal ; Epithelial Cells ; pathology ; Hypersensitivity ; etiology ; Immunoglobulin E ; blood ; Interferon-gamma ; blood ; Interleukin-4 ; blood ; Lipopolysaccharides ; toxicity ; Male ; Ovalbumin ; immunology ; Rats ; Rats, Wistar
9.Expert consensus post-marketing evaluation scheme to detect immunotoxicity of Chinese medicine in clinical populations (draft version for comments).
Yan-Ming XIE ; Yu-Bin ZHAO ; Jun-Jie JIANG ; Yan-Peng CHANG ; Wen ZHANG ; Hao SHEN ; Peng-Fei LU
China Journal of Chinese Materia Medica 2013;38(18):2933-2936
		                        		
		                        			
		                        			Through consensus, establish a post-marketing scheme and the technical processes to evaluate Chinese medicine's immunotoxicity on a population, as well as its beneficial influences on the immune system. Provide regulations on the collection, storage and transportation of serum samples. This article applies to the post-marketing scientific evaluation of the immunotoxicity of parenterally administered, and for other ways of taking Chinese medicine.
		                        		
		                        		
		                        		
		                        			Consensus
		                        			;
		                        		
		                        			Drug Hypersensitivity
		                        			;
		                        		
		                        			etiology
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Drug Monitoring
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			methods
		                        			;
		                        		
		                        			standards
		                        			;
		                        		
		                        			Drugs, Chinese Herbal
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Expert Testimony
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Immunologic Techniques
		                        			;
		                        		
		                        			methods
		                        			;
		                        		
		                        			standards
		                        			;
		                        		
		                        			Product Surveillance, Postmarketing
		                        			;
		                        		
		                        			methods
		                        			;
		                        		
		                        			standards
		                        			;
		                        		
		                        			Th1 Cells
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Th2 Cells
		                        			;
		                        		
		                        			immunology
		                        			
		                        		
		                        	
10.The associations between idiosyncratic adverse drug reactions and HLA alleles and their underlying mechanism.
Qing WANG ; Hu MEI ; Ya-Lan ZHANG ; Xian-Chao PAN ; Wen TAN ; Li CHAO
Acta Pharmaceutica Sinica 2013;48(6):799-808
		                        		
		                        			
		                        			With the advent of Twenty-First century, more and more genome-wide association studies (GWAS) showed that idiosyncratic adverse drug reactions (ADRs) were closely related with human leukocyte antigen (HLA) alleles, such as the associations of abacavir-HLA-B*5701, allopurinol-HLA-B*5801, and carbamazepine-HLA-B*1502, etc. To explore the mechanisms of these idiosyncratic drug reactions, hapten hypothesis, danger signal hypothesis, pharmacological interaction (P-I) concept and autoimmune mechanism are proposed. In this paper, recent GWAS studies on the HLA-mediated adverse drug reactions and underlying mechanism are reviewed in detail.
		                        		
		                        		
		                        		
		                        			Alleles
		                        			;
		                        		
		                        			Allopurinol
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Anti-HIV Agents
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Anticonvulsants
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Carbamazepine
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Dideoxynucleosides
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Drug Hypersensitivity Syndrome
		                        			;
		                        		
		                        			etiology
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Drug-Related Side Effects and Adverse Reactions
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Enzyme Inhibitors
		                        			;
		                        		
		                        			adverse effects
		                        			;
		                        		
		                        			Genome-Wide Association Study
		                        			;
		                        		
		                        			HLA Antigens
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			HLA-B Antigens
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			HLA-B15 Antigen
		                        			;
		                        		
		                        			immunology
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Stevens-Johnson Syndrome
		                        			;
		                        		
		                        			etiology
		                        			;
		                        		
		                        			immunology
		                        			
		                        		
		                        	
            
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