Acquired Immunodeficiency via Autoimmunity: a new AIDS epidemic?

The authors of a recent study in the New England Journal of Medicine (N Engl J Med 2012;367:725-734) screened for autoantibodies against a series of germane immunological cytokines in a set of severely immunodeficient adult patients in Thailand and Taiwan. The patients were selected based on the presence of various stages of opportunistic infection but not HIV. Notably, neutralizing anti-interferon-γ autoantibodies were detected in 88% of adults with multiple opportunistic infections and were associated with an adult-onset immunodeficiency akin to that of advanced HIV infection. The applicability of these results to non-Asian populations has not yet been determined, but these findings certain open up new possibilities for the etiology of acquired immunodeficiency. These results also raise interesting strategies for treatment of this new disease complex. 

Is technology bringing a new era for our patients with anaphylaxis?

Earlier this month, the U.S. Food and Drug Administration (FDA) approved a new epinephrine auto-injector, Auvi-Q, for patients at risk for anaphylaxis. The device provides audio and visual cues that lead patients or caregivers who are administering an injection through the process, step-by-step. The hope is that this system will improve care as surveys have shown that patients at risk of anaphylaxis do not always know how to use their device during an emergency. Do you think this will improve the quality-of-life of our patients with severe anaphylaxis?