Background: Dendritic cells (DC) are potent antigen-presenting cells that have a critical role in regulating immune responses. It is now widely recognized that DC play an important role in allergic diseases in both the initial sensitization phase and in the maintenance of allergic airway inflammation. Methods/Data base: A review of the literature. Results/Conclusion: DC form a close network within the respiratory mucosa, and are rapidly recruited from the circulation in response to allergen challenge. Studies from animal models have indicated that these DC capture allergens from the airway and subsequently prime a T-helper cell type 2 (Th2)-mediated immune response, with the development of airway inflammation. Increased DC numbers are also present in humans with allergic disease and evidence is increasing to suggest that there are functional differences between DC of allergic and normal individuals. While several mechanisms have been proposed to explain how DC are involved in the dysregulated immune response to seemingly harmless allergens in individuals with allergic disease, the exact pathways involved remain to be elucidated. However, it can be seen that DC are one of the central mediators in allergic disease and it will be important to increase our understanding of their role in the allergic setting to provide future therapies.
Background: Our objective was to determine the prevalence and predictor's of allergic diseases (ADs) among 1,978 pregnant women whose birth cohort (1,992 babies) will be followed prospectively for the development of ADs. The increase in ADs among industrialized areas of the world parallels a rising prevalence of ADs among children in the Slovak Republic (SR). Changing outdoor and indoor environmental conditions may be responsible for the rising trend in ADs. Methods: We systematically recruited pregnant women (N = 1,978) delivering at hospitals within environmentally distinct region types of the SR during January 1997-August 1998. Local physicians interviewed the mothers to assess predictors of maternal ADs. The case definition for maternal ADs was a self-report of a physician diagnosis of asthma, hay fever, or eczema. We assessed the relationship between predictors and maternal ADs using univariate and multivariate logistic methods. Results: The prevalence of self-reported ADs was 32.7%. Multivariate analyses showed that several variables were significantly associated with maternal ADs: residing in an industrial region (adjusted odds ratio [aOR]=1.9 [95%CI=1.3, 2.7]); residing in a town rather than a village (aOR=1.7 [95%CI=1.2, 2.5]); residing near heavy traffic (aOR=1.3 [95%CI=1.1, 1.5]); mold growth in the home (aOR=1.7 [95%CI=1.1, 2.6]); and owning a pet (aOR=1.4 [95%CI=1.1, 1.8]). Residence within an industrial region accounted for approximately one-half the total regression score. Conclusions: ADs are common among pregnant women in Slovakia. Outdoor environment-related factors may be more important predictors of ADs among pregnant women in Slovakia than indoor ones.
This is a case report of life-threatening anaphylaxis following the inappropriate use of self-administered parenteral vitamins. The patient was initially evaluated by one of the authors (R.F. Lockey) 1 week after the anaphylactic event.
Seminal B cells from patients with atopic eczema/dermatitis syndrome (AEDS), but not from normal controls, produced IgE spontaneously. This is due to surface IgE+ B cells in AEDS patients' B cells. Sperm from AEDS patients enhanced IgE production by AEDS patients' B cells, while sperm from normal controls failed to do so. Sperm from AEDS patients, but not from normal controls, expressed galectin-3. Preincubation of AEDS patients' sperm with anti-galectin-3 mAb, but not anti-CD23 mAb, abolished enhancement of IgE production by sperm. Moreover, addition of anti-IL-6 mAb, but not anti-IL-10 mAb or antiTNF-α mAb, reversed sperm-induced enhancement of IgE production. Taken together, seminal B cells from patients with AEDS spontaneously produced IgE, which was enhanced by sperm via galectin-3 and IL-6.
Background: There is growing evidence suggesting that air pollution is responsible for the increasing prevalence of asthma in Asia. Exposure to indoor or outdoor air pollutants in communities is relevant to the acute exacerbation as well as the prevalence of asthma. Air pollutants emitted from coal combustion in households may exceed those from industrial resources, and control of such air pollution is of great public health importance. Tobacco smoke is prevalent in Asia and partly responsible for asthma morbidities, despite growing awareness of its adverse respiratory effects. Methods/Data base: A review of the literature. Results: In some Asian studies, respiratory symptoms were found to be more prevalent in individuals living near busy roads than in those whose residence was exposed to larger amounts of pollen allergens and less traffic. This suggests that air pollution could be a risk factor for asthma in addition to atopy. Ambient air pollutants at current levels have been shown to have a harmful effect on more susceptible people in several countries. It is possible that the permissible levels of air pollutants are not sufficiently low for the protection of human health. Because cross-sectional studies cannot confirm a causal relationship for various asthma morbidities, the association with known air pollutants remains suggestive. Conclusions: More carefully designed long-term studies are needed to document the causal effects and dose-response relationship between various air pollutants and asthma. Better technology and public policy are needed to help prevent the enormous suffering and human loss associated with air pollution. What has yet to be documented is whether reduced indoor and outdoor pollution will result in decreased asthma morbidity. Studies to investigate this hypothesis are currently under way.
Background: Children with asthma and a chronically raised residual volume (RV) have early anatomical evidence of chronic obstructive pulmonary disease (COPD). As salbutamol-irreversible flow limitation is the main functional abnormality in COPD, we aimed to test the hypothesis that children with well-controlled asthma and a high RV have significant salbutamol-irreversible limitation in forced expiratory flow at 50% vital capacity (FEF50) in comparison to controls. Methods/Data base: A case-control study design was employed. Pulmonary function (spirometry and plethysmography) was recorded before and after bronchodilator in children with asthma (cases: RV > 100% mean predicted; controls: RV < 100% mean predicted; age: 6-14 years; n = 52 (26 pairs)). Results: Both cases and controls had low FEF50 (mean % predicted (SD): cases 59.3% (23.4%); controls 78.3% (19.9%)) before bronchodilator. However, in cases, FEF50 remained significantly below mean predicted after bronchodilator while, in controls, FEF50 was restored to 90-100% of mean predicted, following bronchodilator administration (mean % predicted (SD) FEF50 74.8% (27.5%) versus FEF50 92.6% (24.6%); p < 0.05)). Similar differences between cases and controls were observed for all other expiratory flow measures that were tested (forced expiratory flows at 25% and 75% vital capacity, peak expiratory flow). In addition, while children with asthma and a high RV experienced a fall, those with a low RV experienced an increase in lung volumes with bronchodilator (ΔRV -26.1% versus +18.1%; 1) < 0.001). Conclusion: The study documents the first-ever evidence of early fixed (salbutamol-irreversible) limitation of forced expiratory flow occuring in children with asthma and a raised RV as compared to controls.
Background: Allergen-specific immunotherapy (SIT) is presently the only available treatment able to change the natural history of allergic disease. Based on a bulk of properly performed studies showing its efficacy and long-term effect, SIT has been approved both by scientific societies and by the WHO for the treatment of patients with respiratory or hymenoptera venom allergy [1,2]. SIT is presently not recommended as a treatment for food allergies, and allergen avoidance remains the only way to prevent potentially life-threatening reactions in patients sensitized to foods. Yet, curing food allergies in exactly the same way (and possibly with the same results) as respiratory allergies remains the dream of many clinical allergologists. The present article reviews the current, limited knowledge of the effects of SIT in patients with food allergy and provides a brief overview of the possible future developments in this field of allergology as well. Methods/Data base: A review of the literature. Results: Studies of injection SIT have shown some clinical efficacy on primary food allergy, albeit at the cost of a high rate of systemic reactions. A number of studies have shown an effect of injection SIT with pollen extracts on allergy to vegetable foods - particularly oral allergy syndrome (OAS) - due to the immunological crossreactivity between some pollen allergens and homologous proteins in plant-derived foods. The effects of sublingual immunotherapy (SLIT) and of the so-called specific oral tolerance induction (SOTI) require further study. Conclusions: At present, allergen avoidance remains the only therapeutic option for food allergy. Although the amount of information is still limited, injection SIT shows some potential to become an effective therapeutic option for food-allergic patients in the future.
Background: The clinical efficacy of allergen-specific immunotherapy in the treatment of allergic respiratory diseases is well documented [1-2]. Moreover, it is the only recognized therapy that can both improve symptoms and modify the natural course of the disease [3-4]. However, the main drawback of this treatment is the risk of inducing systemic reactions (SRs). The frequency and severity of SRs vary among studies depending on patient selection, allergen extracts, and schedules of treatment. Methods/Data base: A review of the literature. The aim of this review is to analyze the frequency of SRs and risks factors of immunotherapy in the studies carried out to define this problem. Results/Conclusions: Though the introduction of standardized extracts and greater attention have significantly reduced the risk of SRs during immunotherapy, this problem has to be carefully evaluated before starting the treatment. Patients have to be well informed not only about the clinical results but also about side effects. In fact, a knowledge of the possibility of systemic reactions is a crucial point for an opportune treatment and for a better compliance; systemic reactions during therapy are one of the most important causes of drop-out. The identification of risk factors is another key point in order to minimize the number of SRs. Most studies have identified the presence of asthma a risk factor for SRs.
Background: Allergen-specific immunotherapy represents a treatment of the basic immunologic dysfunction resulting in the clinical manifestations of allergic diseases. Symptoms may be manifest predominantly in the upper airways (rhinitis) or in the lower airways (asthma), but a significant proportion of allergic patients experience symptoms in both the upper and the lower airways. Advantages of immunotherapy as a disease-modifying specific treatment are the long-term efficacy after terminating treatment, the capacity to prevent the development of new sensitizations in patients allergic to only one allergen, and the down-regulation of the number of rhinitics developing asthma with time. Methods/Data base: A review of the literature. Results/Conclusion: The clinical efficacy of subcutaneous immunotherapy based on placebo-controlled, double-blind studies providing symptom/medication scores published between 1980 and 2003 indicates a clinically relevant reduction in disease severity (efficacy > 30% in addition to the placebo effect) in 80% of 49 studies of rhinitis patients. Asthma is rarely an exclusively allergen-induced disease, and the number of studies evaluating immunotherapy is limited. Of 18 studies, more than 70% document the clinical value of immunotherapy. An essential aspect in obtaining a high clinical efficacy is the indication for immunotherapy. The ideal candidates for immunotherapy are patients with rhinitis and, in the case of asthma, patients experiencing symptoms from both the upper and the lower airways during high allergen exposure as well as patients with symptoms elicited predominantly by allergen-IgE interactions.
Background: Mometasone furoate nasal spray (MFNS) is effective for preventing and treating nasal symptoms in seasonal allergic rhinitis (SAR). Its effects on ocular symptoms have not been investigated. This retrospective analysis examined the effects of MFNS on ocular symptoms in subjects with SAR. Methods/Data base: Ocular symptom data were pooled and analyzed from four randomized, double-blind studies comparing MFNS 200 mcg once daily (n = 494) with placebo (n = 497). Subject-reported ocular itching, redness, and tearing were recorded at baseline and twice daily throughout treatment on a scale of 0 (none) to 3 (severe). Total ocular symptom score (TOSS) was defined as the combined 2-week average symptom scores. Results: MFNS produced a statistically greater reduction in TOSS from baseline as compared to placebo (-1.33 vs. -0.94, p < 0.05). Likewise, mean 2-week reductions in individual symptoms were significantly improved with MFNS (p < 0.05 for each symptom). In subjects with TOSS >= 4 at baseline, MFNS recipients (n = 298) reported a significantly greater reduction in TOSS as compared to placebo recipients (n = 304; -1.97 vs. -1.51, p < 0.05), with statistically significant benefits also observed in individual ocular symptoms (p < 0.05 for each symptom). Conclusions: MFNS has a beneficial effect on ocular symptoms, in addition to its established effects on nasal symptoms, in subjects with SAR.
The IgE-mast cell mediated (Type 1) allergic response is characterized by development of allergen-specific IgE antibodies that trigger an inflammatory reaction following reexposure to allergen. Interaction between allergen and mast cell-bound IgE induces early and late phase inflammation mediated by histamine, prostaglandins, leukotrienes, cytokines, chemokines, and chemotactic factors. Although mast cells are central to the inflammatory response, infiltrating leukocytes such as neutrophils, eosinophils, basophils, and T lymphocytes, also play an important role in the inflammatory cascade. IgE-mediated allergic inflammation is typically observed in allergic conditions of the eye (allergic conjunctivitis), nose (allergic rhinitis), and lungs (asthma). Intermittent (seasonal) and persistent (perennial) allergic conjunctivitis account for 95% of ocular allergies in the United States. The symptoms of allergic conjunctivitis are triggered by inflammatory mediators: Histamine induces itching, redness, watery discharge.. and conjunctival swelling, which may be exacerbated by prostaglandins and leukotrienes; cytokines and chemokines increase leukocyte infiltration, enhancing inflammation and the potential for ocular tissue injury Although symptoms may significantly impair patients' quality of life, allergic conjunctivitis remains underdiagnosed because it is often included under the allergic rhinitis umbrella. In order to increase awareness of allergic conjunctivitis and other allergic conditions, the Nomenclature Review Committee of the World Allergy Organization (WAO) is revising nomenclature and formulating new diagnostic and treatment guidelines in conjunction with the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the Association for Research in Vision and Ophthalmology (ARVO).
Background: Allergic bronchopulmonary aspergillosis (ABPA) is the most frequently recognized manifestation of allergic aspergillosis. This disease with a worldwide distribution was first recognized in England in 1952. ABPA is an immunologically mediated lung disease that is caused by hypersensitivity to the antigen of the fungus Aspergillus, especially A. fumigatus. This potentially destructive lung disease occurs predominantly in patients with asthma. Methods/Data base: A review of the literature. Results: A set of diagnostic criteria is required as there is no single test that establishes the diagnosis apart from demonstration of central bronchiectasis with normal tapering bronchi, a feature considered to be pathognomonic of ABPA. This chronic, relapsing disorder clinically ranges from mild asthma to fibrotic lung disease. Since the first description of ABPA, imaging techniques have been crucial to its diagnosis. Not only do they help to establish the diagnosis, they also help to monitor the progress of the disease. Radiologically, ABPA is characterised by transient pulmonary infiltrates or "fleeting shadows;" often confused with pulmonary tuberculosis. Central bronchiectasis, the hallmark of the disease, is best demonstrated on computed tomography (CT). The immunopathogenesis of the disease is yet to be understood clearly. Specific immunoglobulin E to A. fumigatus (IgE-Af) and immunoglobulin G to A. fumigatus (IgG-Af), the serological markers, contribute to the diagnosis. Oral corticosteroids remain the cornerstone of management. Conclusion: A high index of suspicion is required to establish a diagnosis of ABPA. Asthmatic subjects with a positive skin prick test to Aspergillus antigens must be evaluated for ABPA, and allergic Aspergillus sinusitis (AAS) should be excluded.
Background: In recent years, many authors have stressed the importance of allergic sensitization in the development of otitis media with effusion. The aim of this study was to analyze the role of a continuous or periodic nasal allergenic stimulation in the pathogenesis of secretory otitis media (SOM), and to evaluate eosinophil cationic protein (ECP) in middle ear and blood in children affected by persistent allergic rhinitis. Methods: One hundred children affected by persistent or intermittent allergic rhinitis and otologic symptoms were enrolled in the study. All patients underwent a complete ear, nose and throat (ENT) objective evaluation, an allergologic skin test on the inner forearm (prick test), an evaluation of mucociliary transport time (charcoal powder and 3% saccarine) and a tympamometry. Blood samples were taken from all patients. Children with a persitent type B tympanogram (45) were submitted to myringotomy with ventilation tube insertion; during the surgical procedure, middle ear effusion samples were collected. Results: Children sensitized to perennial allergens presented tympanometric pictures compatible with the existence of SOM more frequently than children sensitized to seasonal allergens. Mean ECP values (mean value ± standard deviation) in blood and middle ear effusion were 25.5 ± 16.3 μg/L and 251 ± 175.2 μg/L (p < 0.001). Conclusions: Our data confirm the direct involvement of middle ear mucosa as shock organ in otitis media developing in patients affected by perennial allergic rhinitis.
Background: The aim of the present study was to assess the effects of mometasone furoate nasal spray on symptoms, quality of life, daytime sleepiness, and objective sleep patterns in seasonal allergic rhinitis. While an increased daytime sleepiness is a well-recognized side effect of allergic rhinits, the effects of a treatment with nasal steroids on daytime sleepiness and nocturnal sleep in perennial allergic rhinitis have only recently been investigated. Methods/Data base: 24 patients with seasonal allergic rhinitis were treated with a 2-week course of mometasone furoate nasal spray during the pollen season in a double-blind, randomized, placebo-controlled trial. Allergy symptoms, daytime sleepiness, and quality of life were assessed with questionnaires (ESS, SF-36, RQLQ). Two nights of polysomnography before and after the treatment were used to evaluate changes in objective sleep patterns. Results: In both groups, allergys ymptoms, nasal airflow, and quality of life parameters improved with treatment. The effects were more pronounced in the mometasone group, leading to significant differences between groups for "nasal symptoms" in the RQLQ. Daytime sleepiness did not improve, and statistically significant changes in objective sleep parameters were only registered for the apnea-hypopnea-index, but were not of clinical relevance. Conclusions: In patients with seasonal allergic rhinitis, nasal steroids lead to an improvement of symptoms and quality of life, but not to a reduction of daytime sleepiness. Clinically relevant changes in objective parameters do not occur. The results support the idea that the increased daytime sleepiness in allergic rhinitis is not a result of an impairment of nocturnal sleep.
Latex allergy can be a serious problem in groups of individuals particularly exposed. Sensitized patients with spina bifida may undergo anaphylaxis at surgery and sensitized health care workers may develop career-ending asthma. Recognition, avoidance of antigen and pharmacotherapy are the mainstay of treatment.