Journal of Allergy The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Treatment of Rhinitis Sicca Anterior with Ectoine Containing Nasal Spray Sun, 13 Apr 2014 00:00:00 +0000 Objectives. The safety and efficacy of ectoine nasal spray and ectoine nasal spray with dexpanthenol in the treatment of rhinitis sicca were evaluated in two studies. Design and Methods. Two noninterventional observational studies were performed to evaluate the efficacy and safety of a nasal spray containing ectoine (study 1) and ectoine/dexpanthenol (study 2) over a period of two weeks including comparable numbers of patients suffering from rhinitis sicca anterior. Patients and physicians were asked to rate the efficacy in reducing symptoms and the tolerability over the treatment phase. Results. The treatment in both studies resulted in a clinical and statistical significant reduction of the main diagnosis parameters, nasal airway obstruction, and crust formation. There was also a significant reduction in the secondary diagnosis parameters in both studies. Importantly, the tolerability was very good. During the whole observational study, neither patients nor doctors stopped the medication due to unwanted effects. Conclusion. Rhinitis sicca could be successfully treated with a nasal spray containing ectoine and a nasal spray combining ectoine with dexpanthenol. The combination of both substances led to slight advantages. Uwe Sonnemann, Olaf Scherner, and Nina Werkhäuser Copyright © 2014 Uwe Sonnemann et al. All rights reserved. The Compatible Solute Ectoine Reduces the Exacerbating Effect of Environmental Model Particles on the Immune Response of the Airways Sun, 13 Apr 2014 00:00:00 +0000 Exposure of humans to particulate air pollution has been correlated with the incidence and aggravation of allergic airway diseases. In predisposed individuals, inhalation of environmental particles can lead to an exacerbation of immune responses. Previous studies demonstrated a beneficial effect of the compatible solute ectoine on lung inflammation in rats exposed to carbon nanoparticles (CNP) as a model of environmental particle exposure. In the current study we investigated the effect of such a treatment on airway inflammation in a mouse allergy model. Ectoine in nonsensitized animals significantly reduced the neutrophilic lung inflammation after CNP exposure. This effect was accompanied by a reduction of inflammatory factors in the bronchoalveolar lavage. Reduced IL-6 levels in the serum also indicate the effects of ectoine on systemic inflammation. In sensitized animals, an aggravation of the immune response was observed when animals were exposed to CNP prior to antigen provocation. The coadministration of ectoine together with the particles significantly reduced this exacerbation. The data indicate the role of neutrophilic lung inflammation in the exacerbation of allergic airway responses. Moreover, the data suggest to use ectoine as a preventive treatment to avoid the exacerbation of allergic airway responses induced by environmental air pollution. Klaus Unfried, Matthias Kroker, Andrea Autengruber, Marijan Gotić, and Ulrich Sydlik Copyright © 2014 Klaus Unfried et al. All rights reserved. Diagnosis of Asthma in Primary Health Care: A Pilot Study Thu, 10 Apr 2014 12:23:38 +0000 Some patients with an asthma diagnosis have a poor controlled asthma. One explanation may be an incorrect diagnosis. Aim. The aim of the study was to diagnose and classify patients with non-infectious lower respiratory tract problems in primary health care using internationally applied diagnostic criteria and diagnostic tests. Patients and Methods. New adult patients visiting a primary health care centre due to lower airway problems were included. The diagnostic tests included FEV1, FVC, PEF, two questionnaires, methacholine test, and skin prick test. Results. The patients () could be divided into four groups: asthma (28%), asthma-like disorder (44%), idiopathic cough (12%), and a nonreversible bronchial obstructive group (16%). The asthma and asthma-like groups showed similar patterns of airway symptoms and trigger factors, not significantly separated by a special questionnaire. Phlegm, heavy breathing, chest pressure/pain, cough, and wheezing were the most common symptoms. Physical exercise and scents were the dominating trigger factors. Conclusions. Nonobstructive asthma-like symptoms seem to be as common as bronchial asthma in primary health care. Due to the similarities in symptoms and trigger factors the study supports the hypothesis that asthma and nonobstructive asthma-like disorders are integrated in the same “asthma syndrome,” including different mechanisms, not only bronchial obstruction. Karin C. Ringsberg, Paula Bjärneman, Ronny Larsson, Elisabeth Wallström, and Olle Löwhagen Copyright © 2014 Karin C. Ringsberg et al. All rights reserved. Hypersensitivity and the Working Environment for Allergy Nurses in Sweden Sun, 06 Apr 2014 08:48:54 +0000 Background. Allergy nurses are exposed to allergens and respiratory irritants, and there are no national guidelines addressing personnel safety when working with these agents. Objective. To investigate the prevalence of allergies, asthma, and hypersensitivity symptoms among allergy nurses and the use of protective equipment and measures when working with allergen concentrates and respiratory irritants. Methods. A questionnaire survey was performed among the members of the Swedish Association of Allergy Nurses. Results. Diagnosed asthma was reported by 17%, while 18% had allergy to pets, 28% had allergy to pollens, and 26% reported nasal symptoms. Fifty-one percent reported a history of asthma, allergic diseases, or hypersensitivity symptoms in their family. Exhaust ventilation was used by 24% during skin prick tests, 17% during allergen specific immunotherapy, and 33% when performing methacholine challenge tests. Tightly closed containers for disposable waste were used by 58% during skin prick tests, by 60% during immunotherapy, and by 40% during Pc provocation tests. Conclusion. Allergy nurses had a tendency to increased prevalence of lower respiratory symptoms, asthma, and allergic rhinitis and more than half of the nurses had a family history of asthma, allergic diseases, or hypersensitivity symptoms. Additional studies are needed to evaluate the validity of these results. Pia Kalm-Stephens, Therese Sterner, Kerstin Kronholm Diab, and Greta Smedje Copyright © 2014 Pia Kalm-Stephens et al. All rights reserved. The Differences and Similarities between Allergists and Non-Allergists for Penicillin Allergy Management Mon, 24 Feb 2014 12:07:29 +0000 The purpose of this study was to compare the management of patients with a history of penicillin allergy between allergists and non-allergists in Thailand. A questionnaire was distributed to Thai physicians by online survey. The answers from 205 physicians were analyzed. The discrepancy of penicillin allergy management between allergists and non-allergists was clearly demonstrated in patients with a history of an immediate reaction in the presence of penicillin skin test () and in patients with a history of Stevens-Johnson syndrome () from penicillin. Allergists are more willing to confirm penicillin allergic status, more likely to carefully administer penicillin even after negative skin test, but less concerned for the potential cross-reactivity with 3rd and 4th generation cephalosporins, compared to non-allergists. The lack of penicillin skin test reagents, the reliability of penicillin allergy history, and medicolegal problem were the main reasons for prescribing alternate antibiotics without confirmation of penicillin allergic status. In summary, the different management of penicillin allergy between allergists and non-allergists was significantly demonstrated in patients with a history of severe non-immediate reaction and in patients with a history of an immediate reaction when a penicillin skin test is available. Nayot Suetrong and Jettanong Klaewsongkram Copyright © 2014 Nayot Suetrong and Jettanong Klaewsongkram. All rights reserved. Exploring Low-Income Families’ Financial Barriers to Food Allergy Management and Treatment Mon, 17 Feb 2014 13:37:38 +0000 Objectives. Low-income families may face financial barriers to management and treatment of chronic illnesses. No studies have explored how low-income individuals and families with anaphylactic food allergies cope with financial barriers to anaphylaxis management and/or treatment. This study explores qualitatively assessed direct, indirect, and intangible costs of anaphylaxis management and treatment faced by low-income families. Methods. In-depth, semistructured interviews with 23 participants were conducted to gain insight into income-related barriers to managing and treating anaphylactic food allergies. Results. Perceived direct costs included the cost of allergen-free foods and allergy medication and costs incurred as a result of misinformation about social support programs. Perceived indirect costs included those associated with lack of continuity of health care. Perceived intangible costs included the stress related to the difficulty of obtaining allergen-free foods at the food bank and feeling unsafe at discount grocery stores. These perceived costs represented barriers that were perceived as especially salient for the working poor, immigrants, youth living in poverty, and food bank users. Discussion. Low-income families report significant financial barriers to food allergy management and anaphylaxis preparedness. Clinicians, advocacy groups, and EAI manufacturers all have a role to play in ensuring equitable access to medication for low-income individuals with allergies. Leia M. Minaker, Susan J. Elliott, and Ann Clarke Copyright © 2014 Leia M. Minaker et al. All rights reserved. Human Lung Mast Cell Products Regulate Airway Smooth Muscle CXCL10 Levels Thu, 06 Feb 2014 13:58:18 +0000 In asthma, the airway smooth muscle (ASM) produces CXCL10 which may attract CXCR3+ mast/T cells to it. Our aim was to investigate the effects of mast cell products on ASM cell CXCL10 production. ASM cells from people with and without asthma were stimulated with IL-1β, TNF-α, and/or IFNγ and treated with histamine (1–100 μM) ± chlorpheniramine (H1R antagonist; 1 μM) or ranitidine (H2R antagonist; 50 μM) or tryptase (1 nM) ± leupeptin (serine protease inhibitor; 50 μM), heat-inactivated tryptase, or vehicle for 4 h or 24 h. Human lung mast cells (MC) were isolated and activated with IgE/anti-IgE and supernatants were collected after 2 h or 24 h. The supernatants were added to ASM cells for 48 h and ASM cell CXCL10 production detected using ELISA (protein) and real-time PCR (mRNA). Histamine reduced IL-1β/TNF-α-induced CXCL10 protein, but not mRNA, levels independent of H1 and H2 receptor activation, whereas tryptase and MC 2 h supernatants reduced all cytokine-induced CXCL10. Tryptase also reduced CXCL10 levels in a cell-free system. Leupeptin inhibited the effects of tryptase and MC 2 h supernatants. MC 24 h supernatants contained TNF-α and amplified IFNγ-induced ASM cell CXCL10 production. This is the first evidence that MC can regulate ASM cell CXCL10 production and its degradation. Thus MC may regulate airway myositis in asthma. H. Alkhouri, V. Cha, K. Tong, L. M. Moir, C. L. Armour, and J. M. Hughes Copyright © 2014 H. Alkhouri et al. All rights reserved. Serum Leptin and Adiponectin Levels in Obese and Nonobese Asthmatic School Children in relation to Asthma Control Tue, 17 Dec 2013 09:39:19 +0000 There is growing evidence of a positive correlation between asthma and obesity in children and adults. Leptin and adiponectin regulate several metabolic and inflammatory functions. This study aims to evaluate serum leptin and adiponectin concentrations in asthmatic school children to investigate their association with obesity and the degree of asthma control. Obese asthmatic (OA) and nonobese asthmatic (NOA) children, aged 7 to 14, were randomly enrolled in this prospective study. Data on demographic, anthropometric, serum lipids, and spirometric measures and allergy status were collected and analyzed. Serum leptin was significantly higher ( versus ; ) and adiponectin levels were lower ( versus ; ) in OA compared to NOA children. The uncontrolled group had higher leptin and lower adiponectin levels compared to well and partially controlled asthma. BMI was positively correlated with leptin (; ) and negatively with adiponectin (; ). Mean BMI and leptin levels were observed to be higher in girls compared to boys. Stepwise multiple linear regression analysis showed that higher BMI and female gender had significant effect on serum leptin levels. Among asthmatic children higher serum leptin and lower adiponectin levels were significantly associated with obesity and showed no significant association with degree of asthma controls. Atqah Abdul Wahab, Muna M. Maarafiya, Ashraf Soliman, Noura B. M. Younes, and Prem Chandra Copyright © 2013 Atqah Abdul Wahab et al. All rights reserved. Mechanistic Understanding of the Effect of Obesity on Asthma and Allergy Thu, 31 Oct 2013 11:20:19 +0000 Anurag Agrawal, Akshay Sood, Allan Linneberg, and Balaram Ghosh Copyright © 2013 Anurag Agrawal et al. All rights reserved. Adiponectin, Leptin, and Resistin in Asthma: Basic Mechanisms through Population Studies Wed, 30 Oct 2013 18:57:45 +0000 Adipokines, factors produced by adipose tissue, may be proinflammatory (such as leptin and resistin) or anti-inflammatory (such as adiponectin). Effects of these adipokines on the lungs have the potential to evoke or exacerbate asthma. This review summarizes basic mechanistic data through population-based and clinical studies addressing the potential role of adipokines in asthma. Augmenting circulating concentrations of adiponectin attenuates allergic airway inflammation and airway hyperresponsiveness in mice. Murine data is supported by human data that suggest that low serum adiponectin is associated with greater risk for asthma among women and peripubertal girls. Further, higher serum total adiponectin may be associated with lower clinical asthma severity among children and women with asthma. In contrast, exogenous administration of leptin results in augmented allergic airway hyperresponsiveness in mice. Alveolar macrophages obtained from obese asthmatics are uniquely sensitive to leptin in terms of their potential to augment inflammation. Consistent with this basic mechanistic data, epidemiologic studies demonstrate that higher serum leptin is associated with greater asthma prevalence and/or severity and that these associations may be stronger among women, postpubertal girls, and prepubertal boys. The role of adipokines in asthma is still evolving, and it is not currently known whether modulation of adipokines may be helpful in asthma prevention or treatment. Akshay Sood and Stephanie A. Shore Copyright © 2013 Akshay Sood and Stephanie A. Shore. All rights reserved. Apgar Score Is Related to Development of Atopic Dermatitis: Cotwin Control Study Wed, 09 Oct 2013 13:21:17 +0000 Aim. To study the impact of birth characteristics on the risk of atopic dermatitis in a twin population. Methods. In a population-based questionnaire study of 10,809 twins, 3–9 years of age, from the Danish Twin Registry, we identified 907 twin pairs discordant for parent-reported atopic dermatitis. We cross-linked with data from the Danish National Birth Registry and performed cotwin control analysis in order to test the impact of birth characteristics on the risk of atopic dermatitis. Results. Apgar score, OR (per unit) = 1.23 (1.06–1.44), , and female sex, OR = 1.31 (1.06–1.61), , were risk factors for atopic dermatitis in cotwin control analysis, whereas birth anthropometric factors were not significantly related to disease development. Risk estimates in monozygotic and dizygotic twins were not significantly different for the identified risk factors. Conclusions. In this population-based cotwin control study, high Apgar score was a risk factor for atopic dermatitis. This novel finding must be confirmed in subsequent studies. Vibeke Naeser, Niklas Kahr, Lone Graff Stensballe, Kirsten Ohm Kyvik, Axel Skytthe, Vibeke Backer, Charlotte Giwercman Carson, and Simon Francis Thomsen Copyright © 2013 Vibeke Naeser et al. All rights reserved. Adverse Reactions to Foods and Food Allergy: Development and Reproducibility of a Questionnaire for Clinical Diagnosis Tue, 01 Oct 2013 11:53:38 +0000 Objective. To develop a questionnaire as a screening tool for adverse reactions to foods in children and to assess the technical reproducibility by test-retest. Methods. Reproducibility of the questionnaire was performed by the literature review, preparing the preliminary questionnaire, peer review, pretest, and retest analysis. The study of the test-retest reproducibility was cross-sectional and descriptive. Kappa coefficient was used to study the reproducibility of the questionnaire. The sample consisted of 125 2–4 year-old children from 15 daycare centers in Recife, Brazil, and interviews with parents or caregivers were used to collect data. Results. From the total children, sixty-three were boys (50.4%), forty-six were two years old (36.8%), forty-seven were three years old (37.6%), and thirty-two were four years old (25.6%). Forty caregivers reported that their child had health problems with food. Most frequently reported offending foods were milk, peanuts, shrimp, and chocolate. Nine questions showed a good Kappa index (≥0,6). Conclusions. The questionnaire used needs to be resized and reshaped on the basis of the issues with good internal consistency and reproducibility. The use of a validated and reproducible questionnaire in the children represents an important contribution towards assessing an eventual rise in overt food allergy. Nilza R. S. Lyra, Maria E. F. A. Motta, Luiz A. R. Rocha, Dirceu Solé, Décio M. Peixoto, José A. Rizzo, Luis Taborda-Barata, and Emanuel S. C. Sarinho Copyright © 2013 Nilza R. S. Lyra et al. All rights reserved. Insulin and the Lung: Connecting Asthma and Metabolic Syndrome Tue, 24 Sep 2013 10:50:19 +0000 Obesity, metabolic syndrome, and asthma are all rapidly increasing globally. Substantial emerging evidence suggests that these three conditions are epidemiologically and mechanistically linked. Since the link between obesity and asthma appears to extend beyond mechanical pulmonary disadvantage, molecular understanding is necessary. Insulin resistance is a strong, independent risk factor for asthma development, but it is unknown whether a direct effect of insulin on the lung is involved. This review summarizes current knowledge regarding the effect of insulin on cellular components of the lung and highlights the molecular consequences of insulin-related metabolic signaling cascades that could adversely affect lung structure and function. Examples include airway smooth muscle proliferation and contractility and regulatory signaling networks that are associated with asthma. These aspects of insulin signaling provide mechanistic insight into the clinical evidence for the links between obesity, metabolic syndrome, and airway diseases, setting the stage for novel therapeutic avenues targeting these conditions. Suchita Singh, Y. S. Prakash, Allan Linneberg, and Anurag Agrawal Copyright © 2013 Suchita Singh et al. All rights reserved. TNF-Alpha Inhibitors for Chronic Urticaria: Experience in 20 Patients Wed, 18 Sep 2013 11:54:13 +0000 Patients with severe chronic urticaria may not respond to antihistamines, and other systemic treatment options may either be ineffective or associated with unacceptable side effects. We present data on efficacy and safety of adalimumab and etanercept in 20 adult patients with chronic urticaria. Twelve (60%) patients obtained complete or almost complete resolution of urticaria after onset of therapy with either adalimumab or etanercept. Further three patients (15%) experienced partial response. Duration of treatment ranged between 2 and 39 months. Those responding completely or almost completely had a durable response with a mean of 11 months. Six patients (30%) experienced side effects and five patients had mild recurrent upper respiratory infections, whereas one patient experienced severe CNS toxicity that could be related to treatment with TNF-alpha inhibitor. Adalimumab and etanercept may be effective and relatively safe treatment options in a significant proportion of patients with chronic urticaria who do not respond sufficiently to high-dose antihistamines or in whom standard immunosuppressive drugs are ineffective or associated with unacceptable side effects. Freja Lærke Sand and Simon Francis Thomsen Copyright © 2013 Freja Lærke Sand and Simon Francis Thomsen. All rights reserved. Factors Associated with the Use of Different Treatment Modalities among Patients with Upper Airway Diseases in Taiwan: A Cross-Sectional Survey Study Sun, 08 Sep 2013 17:53:02 +0000 Rhinitis is a common upper airway disease and can have great impact on patients' quality of life. Factors associated with the use of common treatment modalities among 279 Taiwanese rhinitis patients from the outpatient department of otolaryngology in a medical center were investigated using a cross-sectional survey study. Results from multiple logistic regression analysis, adjusted for etiologies of rhinitis, revealed that males were associated with surgical intervention (OR = 2.11, ). Lower educational level was associated with oral (OR = 2.31, ) and topical medications (OR = 2.50, ). Poor or fair general health status was associated with topical medications (OR = 4.47, ), whereas very good or excellent general health status was inversely associated with surgical intervention (OR = 0.32, ). Smoking was associated with the use of nasal irrigation (OR = 2.72, ). Worse disease-specific quality of life was associated with oral medications (OR = 2.46, ) and traditional Chinese medicine (OR = 5.43, ). In conclusion, the use of different treatment modalities for rhinitis was associated with different combinations of independent factors. Malcolm Koo, Kai-Li Liang, Hsin Tsao, Ting-Ting Yen, Rong-San Jiang, and Yueh-Chiao Yeh Copyright © 2013 Malcolm Koo et al. All rights reserved. Obesity and Asthma: Physiological Perspective Thu, 18 Jul 2013 13:33:30 +0000 Obesity induces some pertinent physiological changes which are conducive to either development of asthma or cause of poorly controlled asthma state. Obesity related mechanical stress forces induced by abdominal and thoracic fat generate stiffening of the lungs and diaphragmatic movements to result in reduction of resting lung volumes such as functional residual capacity (FRC). Reduced FRC is primarily an outcome of decreased expiratory reserve volume, which pushes the tidal breathing more towards smaller high resistance airways, and consequentially results in expiratory flow limitation during normal breathing in obesity. Reduced FRC also induces plastic alteration in the small collapsible airways, which may generate smooth muscle contraction resulting in increased small airway resistance, which, however, is not picked up by spirometric lung volumes. There is also a possibility that chronically reduced FRC may generate permanent adaptation in the very small airways; therefore, the airway calibres may not change despite weight reduction. Obesity may also induce bronchodilator reversibility and diurnal lung functional variability. Obesity is also associated with airway hyperresponsiveness; however, the mechanism of this is not clear. Thus, obesity has effects on lung function that can generate respiratory distress similar to asthma and may also exaggerate the effects of preexisting asthma. Bill Brashier and Sundeep Salvi Copyright © 2013 Bill Brashier and Sundeep Salvi. All rights reserved. The Asthma Phenotype in the Obese: Distinct or Otherwise? Tue, 25 Jun 2013 17:09:49 +0000 Asthma is a heterogenous disorder that can be classified into several different phenotypes. Recent cluster analyses have identified an “obese-asthma” phenotype which is characterized by late onset, female predominance and lack of atopy. In addition, obesity among early-onset asthmatics clearly exists and heightens the clinical presentation. Observational studies have demonstrated that asthma among the obese has a clinical presentation that is more severe, harder to control, and is not as responsive to standard controller therapies. While weight loss studies have demonstrated improvement in asthma outcomes, further studies need to be performed. The current knowledge of the existence of two obesity-asthma phenotypes (early- versus late-onset asthma) should encourage investigators to study these entities separately since just as they have distinct presentations, their course, response to therapies, and weight loss strategies may be different as well. Sherry Farzan Copyright © 2013 Sherry Farzan. All rights reserved. Smooth Muscle Hypercontractility in Airway Hyperresponsiveness: Innate, Acquired, or Nonexistent? Mon, 17 Jun 2013 10:12:46 +0000 Ynuk Bossé, Éric Rousseau, Yassine Amrani, and Michael M. Grunstein Copyright © 2013 Ynuk Bossé et al. All rights reserved. Increased Expression of RhoA in Epithelium and Smooth Muscle of Obese Mouse Models: Implications for Isoprenoid Control of Airway Smooth Muscle and Fibroblasts Tue, 11 Jun 2013 13:30:46 +0000 The simultaneous rise in the prevalence of asthma and obesity has prompted epidemiologic studies that establish obesity as a risk factor for asthma. The alterations in cell signaling that explain this link are not well understood and warrant investigation so that therapies that target this asthma phenotype can be developed. We identified a significant increase in expression of the small GTPase RhoA in nasal epithelial cells and tracheal smooth muscle cells from leptin-deficient (ob/ob) mice compared to their wild-type counterparts. Since RhoA function is dependent on isoprenoid modification, we sought to determine the role of isoprenoid-mediated signaling in regulating the viability and proliferation of human airway smooth muscle cells (ASM) and normal human lung fibroblasts (NHLF). Inhibiting isoprenoid signaling with mevastatin significantly decreased the viability of ASM and NHLF. This inhibition was reversed by geranylgeranyl pyrophosphate (GGPP), but not farnesyl pyrophosphate (FPP), suggesting specificity to the Rho GTPases. Conversely, increasing isoprenoid synthesis significantly increased ASM proliferation and RhoA protein expression. RhoA expression is inherently increased in airway tissue from ob/ob mice, and obesity-entrained alterations in this pathway may make it a novel therapeutic target for treating airway disease in the obese population. Kristie R. Ross, Rebecca J. Darrah, Craig A. Hodges, LaTresa Lang, and Thomas J. Kelley Copyright © 2013 Kristie R. Ross et al. All rights reserved. Mitochondrial Dysfunction in Metabolic Syndrome and Asthma Wed, 05 Jun 2013 13:39:28 +0000 Though severe or refractory asthma merely affects less than 10% of asthma population, it consumes significant health resources and contributes significant morbidity and mortality. Severe asthma does not fell in the routine definition of asthma and requires alternative treatment strategies. It has been observed that asthma severity increases with higher body mass index. The obese-asthmatics, in general, have the features of metabolic syndrome and are progressively causing a significant burden for both developed and developing countries thanks to the westernization of the world. As most of the features of metabolic syndrome seem to be originated from central obesity, the underlying mechanisms for metabolic syndrome could help us to understand the pathobiology of obese-asthma condition. While mitochondrial dysfunction is the common factor for most of the risk factors of metabolic syndrome, such as central obesity, dyslipidemia, hypertension, insulin resistance, and type 2 diabetes, the involvement of mitochondria in obese-asthma pathogenesis seems to be important as mitochondrial dysfunction has recently been shown to be involved in airway epithelial injury and asthma pathogenesis. This review discusses current understanding of the overlapping features between metabolic syndrome and asthma in relation to mitochondrial structural and functional alterations with an aim to uncover mechanisms for obese-asthma. Ulaganathan Mabalirajan and Balaram Ghosh Copyright © 2013 Ulaganathan Mabalirajan and Balaram Ghosh. All rights reserved. Impact of Adiponectin Overexpression on Allergic Airways Responses in Mice Tue, 04 Jun 2013 09:16:12 +0000 Obesity is an important risk factor for asthma. Obese individuals have decreased circulating adiponectin, an adipose-derived hormone with anti-inflammatory properties. We hypothesized that transgenic overexpression of adiponectin would attenuate allergic airways inflammation and mucous hyperplasia in mice. To test this hypothesis, we used mice overexpressing adiponectin (Adipo Tg). Adipo Tg mice had marked increases in both serum adiponectin and bronchoalveolar lavage (BAL) fluid adiponectin. Both acute and chronic ovalbumin (OVA) sensitization and challenge protocols were used. In both protocols, OVA-induced increases in total BAL cells were attenuated in Adipo Tg versus WT mice. In the acute protocol, OVA-induced increases in several IL-13 dependent genes were attenuated in Adipo Tg versus WT mice, even though IL-13 per se was not affected. With chronic exposure, though OVA-induced increases in goblet cells numbers per millimeter of basement membrane were greater in Adipo Tg versus WT mice, mRNA abundance of mucous genes in lungs was not different. Also, adiponectin overexpression did not induce M2 polarization in alveolar macrophages. Our results indicate that adiponectin protects against allergen-induced inflammatory cell recruitment to the airspaces, but not development of goblet cell hyperplasia. Norah G. Verbout, Leandro Benedito, Alison S. Williams, David I. Kasahara, Allison P. Wurmbrand, Huiqing Si, Andrew J. Halayko, Christopher Hug, and Stephanie A. Shore Copyright © 2013 Norah G. Verbout et al. All rights reserved. Avidity Studies in Anisakis simplex-Associated Allergic Diseases Thu, 23 May 2013 14:13:23 +0000 Gastroallergic anisakiasis (GAA) and Anisakis-sensitization-associated chronic urticaria (CU+) differ with respect to specific IgE levels. We hypothesised different immunoglobulin avidities in both entities as well as their dependence on TI and fish consumption. 16 patients with GAA and 17 patients with CU+ were included, and immunoglobulin levels were analysed by CAP (Phadia). IgE and IgG avidity indexes (AvIgE and AvIgG, resp.) were also determined. IgG avidity was higher in GAA than in CU+ (), whereas there was a tendency to lower IgE avidity in GAA (). When analysing all patients, AvIgG was positively correlated with specific IgE, IgG, and IgG4 as well as total IgE (Rho between 0.66 and 0.71; ), but AvIgE was negatively correlated with specific IgE (Rho −0.57; ), specific IgG4 (Rho −0.38; ), and total IgE (Rho 0.66; ). In GAA, weekly fish consumption was positively associated with AvIgE (Rho 0.51; ). A multivariate regression showed that time interval was the main explaining factor for AvIgE in GAA. We could show a differential behaviour of immunoglobulin isotype avidities in both entities and their dependence on fish-eating habits as well as on the time elapsed to the last parasitic episode. Carmen Cuéllar, Ana Valls, Consolación de Frutos, Marta Rodero, and Alvaro Daschner Copyright © 2013 Carmen Cuéllar et al. All rights reserved. Role of Obesity in Asthma Control, the Obesity-Asthma Phenotype Wed, 24 Apr 2013 08:09:35 +0000 Asthma is a disease with distinct phenotypes that have implications for both prognosis and therapy. Epidemiologic studies have demonstrated an association between asthma and obesity. Further studies have shown that obese asthmatics have poor asthma control and more severe asthma. This obese-asthma group may represent a unique phenotype. The mechanisms behind poor asthma control in obese subjects remain unclear, but recent research has focused on adipokines and their effects on the airways as well as the role of oxidative stress. Both surgical and nonsurgical weight loss therapy have shown promising results with improvements in asthma control and decreased asthma severity. Comorbid conditions such as gastroesophageal reflux disease and obstructive sleep apnea may also have a role in poor asthma control in obese asthmatics. Further research is needed to define the mechanisms behind this phenotype which will guide the development of targeted therapies. Shannon Novosad, Supriya Khan, Bruce Wolfe, and Akram Khan Copyright © 2013 Shannon Novosad et al. All rights reserved. Arginine and Nitric Oxide Pathways in Obesity-Associated Asthma Sun, 21 Apr 2013 11:08:09 +0000 Obesity is a comorbidity that adversely affects asthma severity and control by mechanisms that are not fully understood. This review will discuss evidence supporting a role for nitric oxide (NO) as a potential mechanistic link between obesity and late-onset asthma (>12 years). Several studies have shown that there is an inverse association between increasing body mass index (BMI) and reduced exhaled NO. Newer evidence suggests that a potential explanation for this paradoxical relationship is related to nitric oxide synthase (NOS) uncoupling, which occurs due to an imbalance between L-arginine (NOS substrate) and its endogenous inhibitor, asymmetric di-methyl arginine (ADMA). The review will propose a theoretical framework to understand the relevance of this pathway and how it may differ between early and late-onset obese asthmatics. Finally, the paper will discuss potential new therapeutic approaches, based on these paradigms, for improving the respiratory health of obese subjects with asthma. Fernando Holguin Copyright © 2013 Fernando Holguin. All rights reserved. Use of Animal Models to Investigate Major Allergens Associated with Food Allergy Thu, 11 Apr 2013 11:58:09 +0000 Food allergy is an emerging epidemic that affects all age groups, with the highest prevalence rates being reported amongst Western countries such as the United States (US), United Kingdom (UK), and Australia. The development of animal models to test various food allergies has been beneficial in allowing more rapid and extensive investigations into the mechanisms involved in the allergic pathway, such as predicting possible triggers as well as the testing of novel treatments for food allergy. Traditionally, small animal models have been used to characterise immunological pathways, providing the foundation for the development of numerous allergy models. Larger animals also merit consideration as models for food allergy as they are thought to more closely reflect the human allergic state due to their physiology and outbred nature. This paper will discuss the use of animal models for the investigation of the major food allergens; cow's milk, hen's egg, and peanut/other tree nuts, highlight the distinguishing features of each of these models, and provide an overview of how the results from these trials have improved our understanding of these specific allergens and food allergy in general. Jenna L. Van Gramberg, Michael J. de Veer, Robyn E. O'Hehir, Els N. T. Meeusen, and Robert J. Bischof Copyright © 2013 Jenna L. Van Gramberg et al. All rights reserved. Airway Smooth Muscle Hypercontractility in Asthma Mon, 18 Mar 2013 10:08:17 +0000 In recent years, asthma has been defined primarily as an inflammatory disorder with emphasis on inflammation being the principle underlying pathophysiological characteristic driving airway obstruction and remodelling. Morphological abnormalities of asthmatic airway smooth muscle (ASM), the primary structure responsible for airway obstruction seen in asthma, have long been described, but surprisingly, until recently, relatively small number of studies investigated whether asthmatic ASM was also fundamentally different in its functional properties. Evidence from recent studies done on single ASM cells and on ASM-impregnated gel cultures have shown that asthmatic ASM is intrinsically hypercontractile. Several elements of the ASM contraction apparatus in asthmatics and in animal models of asthma have been found to be different from nonasthmatics. These differences include some regulatory contractile proteins and also some components of both the calcium-dependent and calcium-independent contraction signalling pathways. Furthermore, oxidative stress was also found to be heightened in asthmatic ASM and contributes to hypercontractility. Understanding the abnormalities and mechanisms driving asthmatic ASM hypercontractility provides a great potential for the development of new targeted drugs, other than the conventional current anti-inflammatory and bronchodilator therapies, to address the desperate unmet need especially in patients with severe and persistent asthma. Rachid Berair, Fay Hollins, and Christopher Brightling Copyright © 2013 Rachid Berair et al. All rights reserved. Roles of IL-22 in Allergic Airway Inflammation Thu, 21 Feb 2013 10:32:44 +0000 IL-23- and IL-17A-producing CD4+ T cell (Th17 cell) axis plays a crucial role in the development of chronic inflammatory diseases. In addition, it has been demonstrated that Th17 cells and their cytokines such as IL-17A and IL-17F are involved in the pathogenesis of severe asthma. Recently, IL-22, an IL-10 family cytokine that is produced by Th17 cells, has been shown to be expressed at the site of allergic airway inflammation and to inhibit allergic inflammation in mice. In addition to Th17 cells, innate lymphoid cells also produce IL-22 in response to allergen challenge. Functional IL-22 receptor complex is expressed on lung epithelial cells, and IL-22 inhibits cytokine and chemokine production from lung epithelial cells. In this paper, we summarize the recent progress on the roles of IL-22 in the regulation of allergic airway inflammation and discuss its therapeutic potential in asthma. Koichi Hirose, Kentaro Takahashi, and Hiroshi Nakajima Copyright © 2013 Koichi Hirose et al. All rights reserved. Swimming and Asthma: Differences between Women and Men Wed, 20 Feb 2013 16:08:47 +0000 Background and Aim. Asthma is common in endurance athletes including swimmers. Our aim was to study gender differences in asthma, allergy, and asthmatic symptoms in swimmers and investigate the effects of varying intensities of physical exercise on competitive swimmers with asthma. Methods. Three hundred highly trained swimmers (156 females and 144 males) were studied by a questionnaire. Their mean (±SD) ages were and years, and they had training history of and years in females and males, respectively. Gender differences in asthma, allergy, and respiratory symptoms were examined. Special attention was focused on asthmatic swimmers, their allergies and respiratory symptoms during swimming at different intensities. Results. The prevalence of physician-diagnosed asthma was 19% for females and males. No gender differences in asthma or respiratory symptoms were found. Males reported allergies significantly more often than females (). Gender difference was found in respiratory symptoms among swimmers with physician-diagnosed asthma because females reported symptoms significantly more often () than males. Asthmatic females also reported symptoms significantly more often at moderate intensity swimming () than males especially for coughing. Discussion. Gender difference in prevalence of asthma was not found in swimmers. However, allergy was reported significantly more by male swimmers. Male swimmers with asthma reported significantly more cases having family history of asthma, which may be a sign of selection of asthma-friendly sport. Moderate intensity swimming seemed to induce significantly more symptoms especially coughing in asthmatic females. Marja Kristiina Päivinen, Kari Lasse Keskinen, and Heikki Olavi Tikkanen Copyright © 2013 Marja Kristiina Päivinen et al. All rights reserved. An Important Role of Blood and Lymphatic Vessels in Inflammation and Allergy Thu, 31 Jan 2013 16:53:55 +0000 Angiogenesis and lymphangiogenesis, the growth of new vessels from preexisting ones, have received increasing interest due to their role in tumor growth and metastatic spread. However, vascular remodeling, associated with vascular hyperpermeability, is also a key feature of many chronic inflammatory diseases including asthma, atopic dermatitis, psoriasis, and rheumatoid arthritis. The major drivers of angiogenesis and lymphangiogenesis are vascular endothelial growth factor- (VEGF-)A and VEGF-C, activating specific VEGF receptors on the lymphatic and blood vascular endothelium. Recent experimental studies found potent anti-inflammatory responses after targeted inhibition of activated blood vessels in models of chronic inflammatory diseases. Importantly, our recent results indicate that specific activation of lymphatic vessels reduces both acute and chronic skin inflammation. Thus, antiangiogenic and prolymphangiogenic therapies might represent a new approach to treat chronic inflammatory disorders, including those due to chronic allergic inflammation. Silvana Zgraggen, Alexandra M. Ochsenbein, and Michael Detmar Copyright © 2013 Silvana Zgraggen et al. All rights reserved. Crosstalk between Innate and Adaptive Cells on Allergic Process Wed, 26 Dec 2012 09:48:35 +0000 Maria Leite-de-Moraes, Hamida Hammad, and Michel Dy Copyright © 2012 Maria Leite-de-Moraes et al. All rights reserved.