ARTICLE INFO

Article Type

Original Research

Authors

Askary   N. (1 )
Ghazanfari   T. (* )
Jalayi   Sh. (2 )
Soroush   M.R. (3 )
Davoudi   S.M. (4 )






(* ) “Immunoregulation Research Center” and “Immunology Department, Medicine Faculty”, Shahed University, Tehran, Iran
(1 ) Biology Department, Sciences Faculty, Shahid Bahonar University of Kerman, Kerman, Iran
(2 ) Biostatistics Department, Rehabilitation Faculty, Tehran University of Medical Sciences, Tehran, Iran
(3 ) Janbazan Medical and Engineering Research Center(JMERC), Tehran, Iran
(4 ) Dermatology Department, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

Correspondence

Article History

Received:  June  21, 2014
Accepted:  October 3, 2014
ePublished:  September 20, 2014

BRIEF TEXT


… [1] More disorders, due to mustard gas are occurred in the respiratory system, eyes, and skin [2]. The effects of mustard gas on body depend on measure and exposure length [3]. During exposure, 10% to 20% of mustard gas is absorbed by skin; and it seems that 12% to 50% of the absorbed gas reacts with skin, of which 7% and 3% remaining in epidermis and dermis respectively [4]. … [5] Different kinds of skin disorders in the veterans have been reported including itching, burning skin, dry skin, scars, cherry angioma. In addition, significant prevalence of urticaria, seborrheic dermatitis, eczema, hair loss, and acne lesions has been reported [6-10]. Urticaria is skin disorder with complex etiopathogenesis, which might be caused by different causes. Urticaria more than 6 weeks is diagnosed as chronic [11]. Different chemical agents like histamine, leukotrienes, prostaglandins, and cytokines secreted by mast cells and basophils are involved in pathogenesis of urticaria [12].

More incidence of chronic urticaria in the chemically-injured veterans than healthy peoples, being resistant to the conventional therapies have been reported [10, 13, 14]. Recently, significant progresses on determination of the cause and pathogenesis of urticaria have been made. However, there is little information about incidence mechanism of urticaria due to mustard gas. In severe and chronic processes caused by mustard gas, inflammatory cytokines play important roles [15-17]. In the recent studies, significant correlation between skin complaints due to mustard gas and changes in serum levels of cytohins has been reported [17, 18]. Different studies on kinds of urticaria have shown different change patterns in immune mediators [19-21]. Nevertheless, the correlation between cytokines and urticaria arises from mustard gas has not still been evaluated.

The aim of this study was to evaluate association between Interleukin-18 and its binding protein and chronic urticaria in veterans with chemical injuries.

This is a historical cohort study and a part of a comprehensive plan [1].

Persons with mustard gas exposure (chemically-injured veterans of Sardasht City, Iran) and healthy persons (from Rabat City, Iran) were studied.

The sample size (372 persons with mustard gas exposure and 128 healthy persons) was determined through consultation with statistic experts and with citation to other studies [1]. The samples of both ‘exposed’ and ‘control’ groups were homogenized in terms of sex, age, body mass index, and marital status. Sardasht and Rabat cities were very similar to each other in geographic location, climate, customs, and nutrition. Systematic random sampling was done. Male veterans recorded on the list of Sardasht City Veterans Organization and male persons recorded on the family list of Rabat Municipality were considered to select the members of ‘exposed’ and ‘control’ groups, respectively. All subjects were studied and divided by an experienced skin specialist for skin disorders such as urticaria.

During clinical examinations and in sterile conditions, 2cc of peripheral blood were taken from each person and clotted at room temperature or 37℃. Interleukin-18 serum levels and binding protein of the samples were measured by sandwich ELISA method using kit (R&D; USA), measured with ELIZA reader system (Bio Tek; USA). Mann-Whitney test was used to compare cytokines serum levels in the groups.

From exposed and control groups, 8 persons (2.1%) and 1 person (0.8%), without any reported results, had chronic urticaria disorder, respectively (Table 1). The mean level of Interleukin-18 in patients with urticaria of exposed group (194.41±80.31pg/ml) was more than that of all others. There was no significant difference between the measure and the mean level of samples without urticaria of control group (154.91±60.44pg/ml). Nevertheless, there was significant difference between it with samples without urticarial of exposed group (133.26±54.52pg/ml). The mean level of binding protein in samples with no urticaria of exposed group (515.86±575.66pg/ml) was more than that of all others. There was no significant difference between the mean level of the index in patients with urticaria of exposed group (376.83±451.92pg/ml) and the mean level of samples without urticaria of control group (230.45±328.03pg/ml).

The results showed more serum Interleukin-18 in chemically-injured veterans with chronic urticaria than chemically-injured veterans without urticaria disorder. Serum measure comparison of the binding protein of Interleukin-18 as a natural inhibitor approximately confirms the above pattern. A study on patients with chronic idiopathic urticaria has shown increase in the circulating levels of Interleukins 18, 13, and 4, which shows role of immune mediators in the incidence of chronic urticaria [22]. Immune dysfunction and increases in ccl2 and cxcl8 in chronic idiopathic urticaria have been observed [20]. There is ccl5 increase in chronic spontaneous urticaria [21]. Based on the results of several researches, it is suggested that there is an important pathologic role for Interleukin-18 in chronic inflammatory conditions in epithelial organs, like skin, intestine, and kidney and allergic disorders [23, 24]. … [25-28] Despite the fact that there is no study on association of Interleukin-18 with urticaria produced by mustard gas exposure, role for Interlekin-18 has been reported in the diseases with incidence of urticaria. There are increases in Interleukin-18 in chronic ordinary urticaria [22, 29] and salicylic acid induced urticaria [30]. There are increases in serum levels of Interleukin-18 in patients with Schnitzler syndrome associated with incidence of chronic urticarial [31], as well as in atopic dermatitis disorder [32]. In patients with spontaneous urticaria, increase in Interleukin-18 expression has been observed [30], while it has not been confirmed in some studies [22].

Studies on the damaged tissues in urticaria area ought to be conducted for samples which are provided for diagnosis and treatment.

This is a study was done on serum samples. More decisive results can be achieved through studies on the local expressions of molecules, which was not achievable for the researchers due to limited availability of tissue samples alongside moral limitations.

Interleukin-18 may be involved in incidence of urticaria induced by mustard gas.

The researchers feel grateful to all who participated in the study.

Non-declared

Non-declared

As a section of Sardasht Cohort Study, the research was funded by Foundation of Martyrs and Veterans Affairs, Ministry of Health and Medical Education, Shahed University, and Janbazan Medical and Engineering Research Center

TABLES and CHARTS

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CITIATION LINKS

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