BioMed Research International: Allergy The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Acute Asthma in the Pediatric Emergency Department: Infections Are the Main Triggers of Exacerbations Thu, 12 Oct 2017 00:00:00 +0000 Background. Asthma exacerbations are a common reason for Emergency Department (ED) visits in children. Aim. To analyze differences among age groups in terms of triggering factors and seasonality and to identify those with higher risk of severe exacerbations. Methods. We retrospectively revised the files of children admitted for acute asthma in 2016 in our Pediatric ED. Results. Visits for acute asthma were 603/23197 (2.6%). 76% of the patients were <6 years old and 24% ≥6. Infections were the main trigger of exacerbations in both groups; 33% of the school-aged children had a triggering allergic condition (versus 3% in <6 years; ). 191 patients had a previous history of asthma; among them, 95 were ≥6 years, 67% of whom were not using any controller medication, showing a higher risk of a moderate-to-severe exacerbation than those under long-term therapy (). Exacerbations peaked in autumn and winter in preschoolers and in spring and early autumn in the school-aged children. Conclusions. Infections are the main trigger of acute asthma in children of any age, followed by allergy in the school-aged children. Efforts for an improved management of patients affected by chronic asthma might go through individualized action plans and possibly vaccinations and allergen-avoidance measures. Arianna Dondi, Elisabetta Calamelli, Valentina Piccinno, Giampaolo Ricci, Ilaria Corsini, Carlotta Biagi, and Marcello Lanari Copyright © 2017 Arianna Dondi et al. All rights reserved. Risk Factors of Allergic Disease: A Study with a Large Data Set Tue, 10 Oct 2017 00:00:00 +0000 In-Hwan Oh, Yeong-Ho Rha, Takao Fujisawa, and Kyung Suk Lee Copyright © 2017 In-Hwan Oh et al. All rights reserved. Home Remodeling and Food Allergy Interact Synergistically to Increase the Risk of Atopic Dermatitis Wed, 20 Sep 2017 00:00:00 +0000 Purpose. The purpose of this study was to investigate the effects of home remodeling and food allergy (FA) on the development of atopic dermatitis (AD) in children. Methods. The Modified International Study of Asthma and Allergies in Childhood questionnaire was used to survey 4,111 children recruited from 3 kindergartens and 6 elementary schools from Seongnam, Korea. Participants’ parents agreed for them to participate in physical examinations, skin prick tests, and blood tests. Results. Home remodeling in the past 12 months (adjusted odds ratio [aOR] 3.40, ), lifetime diagnosis of FA (aOR 3.95, ), parental history of AD (aOR 2.67, ), and FA (aOR 2.35, ) were independent risk factors for lifetime diagnosis of AD ever. When history of home remodeling and FA were combined, the risk for moderate-to-severe AD by scoring atopic dermatitis (SCORAD) score increased (aOR, 7.19, , P for interaction = 0.034). Conclusion. Home remodeling, lifetime diagnosis of FA, parental history of AD, and parental history of FA were independent risk factors for AD. In addition, we observed a synergistic interaction between home remodeling and FA in the risk of moderate-to-severe AD. Won Seok Lee, Kyung Suk Lee, Shinhae Lee, Myongsoon Sung, Seung-Jin Lee, Hye Mi Jee, Youn Ho Sheen, Man Yong Han, and Young-Ho Jung Copyright © 2017 Won Seok Lee et al. All rights reserved. Association between Exposure to Traffic-Related Air Pollution and Prevalence of Allergic Diseases in Children, Seoul, Korea Wed, 13 Sep 2017 00:00:00 +0000 Although there has been suggestive evidence of the association between TRAP and ADs, findings remained inconsistent possibly due to limited population. We investigated the association between TRAP and ADs in a large population of children with rich spatial coverage and expanded age span in Seoul, Korea. TRAP exposures were estimated by categorized proximity to the nearest major road (≤150, 150–300, 300–500, and >500 m) and density of major roads within 300 meters from children’s residences. We estimated the association between two TRAP exposures and three ADs using generalized mixed model after adjusting for individual characteristics. We also investigated whether the association varied by household and regional socioeconomic status. We found associations of atopic eczema with road density [OR = 1.08; 95% CI = 1.01–1.15] and road proximity [1.15, 1.01–1.32; 1.17, 1.03–1.34; and 1.16, 1.01–1.34 for ≤150, 150–300, and 300–500 m, resp., compared to >500 m]. There was no association with asthma and allergic rhinitis. Effect estimates were generally the highest in the low socioeconomic region. Children living in areas surrounded by large and busy roads were likely to be at greater risks for atopic eczema, with increased vulnerability when living in deprived areas. Seon-Ju Yi, Changwoo Shon, Kyung-Duk Min, Hwan-Cheol Kim, Jong-Han Leem, Ho-Jang Kwon, Soyoung Hong, KyooSang Kim, and Sun-Young Kim Copyright © 2017 Seon-Ju Yi et al. All rights reserved. Analysis of Epidemiology and Risk Factors of Atopic Dermatitis in Korean Children and Adolescents from the 2010 Korean National Health and Nutrition Examination Survey Tue, 22 Aug 2017 00:00:00 +0000 Background. Atopic dermatitis (AD) is a common chronic inflammatory skin disease, but only few studies involved samples of children and adolescents that are representative of the entire Korean population. This study aimed to estimate the prevalence and risk factors of AD among children and adolescents in Korea by using nationally representative data. Methods. We used data from the fifth Korean National Health and Nutrition Examination Survey in 2010 and retrospectively evaluated 2,116 children and adolescents. Logistic regression analysis was performed to determine the relationship between AD and other variables, including IgE levels. Results. The prevalence rate of AD in children and adolescents was 15.0%. In the multivariate analysis of ages from 1 to 18 years, age (adjusted odds ratio [aOR], 0.96; ) was related to AD. From age of 12 to 18 years, smoking (aOR, 8.99; ) and elevated total IgE serum level (aOR, 5.31; ) were related to AD. Conclusion. Age, smoking, and elevated total IgE level were related to AD in the children and adolescents. Thus, an antismoking policy and public education are necessary for reducing the prevalence of allergic diseases. In addition, measurement of total IgE level and age may be helpful in the diagnosis of AD. Kyung Suk Lee, In-Hwan Oh, Sun Hee Choi, and Yeong-Ho Rha Copyright © 2017 Kyung Suk Lee et al. All rights reserved. The Prevalence of Ocular Allergy and Comorbidities in Chinese School Children in Shanghai Mon, 21 Aug 2017 00:00:00 +0000 Objective. To investigate the prevalence and features of ocular allergy (OA) and comorbidities among school children in Shanghai, China. Methods. This was a population-based cross-sectional study. Each participant completed an ISAAC-based questionnaire. The prevalence of OA symptoms, allergic rhinitis (AR) asthma, atopic dermatitis (AD), and sensitization to mites, pollen, and food was analyzed. Results. A total of 724 and 942 completed questionnaires from the 7–9-year-old (young group) and the 12–14-year-old (teen group) groups were analyzed, respectively. The overall prevalence of OA symptoms was 28%. However, more young students (10.6%) reported mild to severe daily life interference caused by OA than the teens (5.7%). The young group had higher prevalence of diagnosed allergic conjunctivitis (10.2%). The overall prevalence of AR symptom, diagnosed asthma, and diagnosed AD was 40.4%, 11.6%, and 16.7%, respectively. Young children had higher prevalence of diagnosed AR and AD than the teens. There were gender associated differences in the prevalence of AR and asthma among young children, but not among the teens. The comorbidities associated with OA was also analyzed. Sensitization to mites, food, and pollen was associated with higher prevalence of allergic conditions. Conclusions. OA together with other allergic conditions affected a significant number of children in Shanghai. Yanqing Feng, Xiangning Wang, Fang Wang, Rongming Liu, Lu Chen, Shuqin Wu, Xia Yang, Miaoying Chen, Yu-Qing Rao, and Jing Li Copyright © 2017 Yanqing Feng et al. All rights reserved. Effect of Pregnancy on Quantitative Medication Use and Relation to Exacerbations in Asthma Thu, 20 Jul 2017 08:52:54 +0000 Background. The quantification of asthma medication reduction and its relation to an aggravation of asthma during pregnancy at an individual level are unclear. Methods. We conducted a nationwide retrospective cohort study of asthmatic pregnant women in South Korea. All of the asthma medications were ranked from 1 to 4 according to the guideline-based stepwise approach. We assessed the daily sums of the ranks of the asthma medications and their association with exacerbations during three phases based on the individual’s delivery date: before, during, and after pregnancy. Results. The study cohort included 115,169 asthmatic pregnant women who gave birth between 2011 and 2013. The subjects were clustered into four groups according to the daily rank sums of their asthma medication. Asthma medications were rapidly reduced at the beginning of the pregnancy and then slowly increased after delivery. Exacerbations were more frequent in the group with higher rank-sum values than in the group with lower values. Overall exacerbations were reduced during pregnancy compared to before or after delivery. Conclusions. Asthmatic pregnant women tended to reduce their asthma medication use during pregnancy. This led to a greater number of exacerbations in a small part of the study population. So-My Koo, Yunsun Kim, Chorong Park, Gun Woo Park, MoonGyu Lee, Sungho Won, and Hyeon-Jong Yang Copyright © 2017 So-My Koo et al. All rights reserved. Predictors of Inappropriate Use of Diagnostic Tests and Management of Bronchiolitis Mon, 03 Jul 2017 00:00:00 +0000 Background. The aim of the present study was to determine predictors of inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. Methods. In an analytical cross-sectional study, we determined independent predictors of the inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. We defined a composite outcome score as the main outcome variable. Results. Of the 303 included patients, 216 (71.3%) experienced an inappropriate use of diagnostic tests and treatment of bronchiolitis. After controlling for potential confounders, it was found that atopic dermatitis (OR 5.30; CI 95% 1.14–24.79; ), length of hospital stay (OR 1.48; CI 95% 1.08–2.03; ), and the number of siblings (OR 1.92; CI 95% 1.13–3.26; ) were independent predictors of an inappropriate use of diagnostic tests and treatment of the disease. Conclusions. Inappropriate use of diagnostic tests and treatment of bronchiolitis was a highly prevalent outcome in our population of study. Participants with atopic dermatitis, a longer hospital stay, and a greater number of siblings were at increased risk for inappropriate use of diagnostic tests and management of the disease. Lorena Sarmiento, Gladys E. Rojas-Soto, and Carlos E. Rodríguez-Martínez Copyright © 2017 Lorena Sarmiento et al. All rights reserved. Clinical Implications of Oscillatory Lung Function during Methacholine Bronchoprovocation Testing of Preschool Children Tue, 27 Jun 2017 07:33:36 +0000 Objective. To investigate the repeatability and safety of measuring impulse oscillation system (IOS) parameters and the point of wheezing during bronchoprovocation testing of preschool children. Methods. Two sets of methacholine challenge were conducted in 36 asthma children. The test was discontinued if there was a significant change in reactance (Xrs5) and resistance (Rrs5) at 5 Hz (Condition 1) or respiratory distress due to airway obstruction (Condition 2). The repeatability of PC80_Xrs5, PC30_Rrs5, and wheezing (PCw) was assessed. The changes in -scores and SD-indexes from prebaseline (before testing) to postbaseline (after bronchodilator) were determined. Results. For PC30_Rrs5, PC80_Xrs5, and PCw for subjects, PC80_Xrs5 showed the highest repeatability. Fifteen of 70 tests met Condition . The changes from pre- and postbaseline values varied significantly for Rrs5 and Xrs5. Excluding subjects with -scores higher than 2SD, we were able to detect 97.1% of bronchial hyperresponsiveness during methacholine challenge based on the change in Rrs5 or Xrs5. A change in IOS parameters was associated with wheezing at all frequencies. Conclusion. Xrs5 and Rrs5 have repeatability comparable with FEV1, and Xrs5 is more reliable than Rrs5. Clinicians can safely perform a challenge test by measuring the changes in Rrs5, Xrs5, and -scores from the prebaseline values. Sun Hee Choi, Youn Ho Sheen, Mi Ae Kim, Ji Hyeon Baek, Hey Sung Baek, Seung Jin Lee, Jung Won Yoon, Yeong Ho Rha, and Man Yong Han Copyright © 2017 Sun Hee Choi et al. All rights reserved. Metals Are Important Contact Sensitizers: An Experience from Lithuania Thu, 16 Mar 2017 00:00:00 +0000 Background. Metals are very frequent sensitizers causing contact allergy and allergic contact dermatitis worldwide; up-to-date data based on patch test results has proved useful for the identification of a problem. Objectives. In this retrospective study prevalence of contact allergy to metals (nickel, chromium, palladium, gold, cobalt, and titanium) in Lithuania is analysed. Patients/Methods. Clinical and patch test data of 546 patients patch tested in 2014–2016, in Vilnius University Hospital Santariskiu Klinikos, was analysed and compared with previously published data. Results. Almost third of tested patients (29.56%) were sensitized to nickel. Younger women were more often sensitized to nickel than older ones (36% versus 22.8%, ). Women were significantly more often sensitized to nickel than men (33% versus 6.1%, ). Younger patients were more often sensitized to cobalt (11.6% versus 5.7%, ). Sensitization to cobalt was related to sensitization to nickel (). Face dermatitis and oral discomfort were related to gold allergy (28% versus 6.9% dermatitis of other parts, ). Older patients were patch test positive to gold(I) sodium thiosulfate statistically significantly more often than younger ones (44.44% versus 21.21%, ). Conclusions. Nickel, gold, cobalt, and chromium are leading metal sensitizers in Lithuania. Cobalt sensitization is often accompanied by sensitization to nickel. Sensitivity rate to palladium and nickel indicates possible cross-reactivity. No sensitization to titanium was found. Kotryna Linauskienė, Laura Malinauskienė, and Audra Blažienė Copyright © 2017 Kotryna Linauskienė et al. All rights reserved. Survey of Occupational Allergic Contact Dermatitis and Patch Test among Clothing Employees in Beijing Wed, 15 Mar 2017 00:00:00 +0000 Occupational population-based epidemiological data relating to occupational contact allergies in the Chinese clothing industry are limited. To investigate the prevalence of occupational allergic contact dermatitis (OACD) and to identify the causative allergens among clothing employees in China, a cross-sectional study was conducted in 529 clothing employees at 12 clothing factories in Beijing. All employees were subjected to an interview using self-administered questionnaire and skin examination, and those who were diagnosed with occupational contact dermatitis (OCD) were patch tested. In the present survey, we found that the overall 1-year prevalence of OACD among the clothing employees was 8.5%. The 1-year prevalence of OACD among workers (10.8%) was significantly higher than that among managers (3.2%). The lesions were primarily on the hands and wrists in workers, but the face and neck in managers. The major allergens were nickel sulfate and cobalt dichloride in workers and colophony and p-tert-butylphenol formaldehyde resin in managers. In conclusion, workers are at a higher risk of OACD compared with managers in the Chinese clothing industry. In addition to hand dermatitis in workers, airborne contact dermatitis on the face and neck should be also addressed in managers. Yu-Xin Chen, Bing-Ai Gao, Hai-Yan Cheng, and Lin-Feng Li Copyright © 2017 Yu-Xin Chen et al. All rights reserved. Usefulness of Sweat Management for Patients with Adult Atopic Dermatitis, regardless of Sweat Allergy: A Pilot Study Sun, 22 Jan 2017 00:00:00 +0000 Background. Sweat is an aggravating factor in atopic dermatitis (AD), regardless of age. Sweat allergy may be involved in AD aggravated by sweating. Objective. We investigated whether sweat exacerbates adult AD symptoms and examined the extent of sweat allergy’s involvement. Method. We asked 34 AD patients (17 men, 17 women; mean age: 27.8 years) to record the extent to which sweat aggravated their symptoms on a 10-point numerical scale. Participant responses were compared with histamine release tests (HRT). Furthermore, 24 of the patients received instructions on methods of sweat management, and their outcomes were evaluated on a 10-point scale. Results. Sweat HRT results were class ≥ 2 in 13 patients, but HRT results were not correlated with the patients’ self-assessments of symptom aggravation by sweat. One month after receiving sweat management instructions, a low mean score of 4.6 was obtained regarding whether active sweating was good, but a high mean score of 7.0 was obtained in response to whether the sweat management instructions had been helpful. Conclusion. Our investigation showed that patients’ negative impressions of sweat might derive from crude personal experiences that are typically linked to sweating. Sweat management for patients with adult atopic dermatitis was extremely useful regardless of sweat allergy. Sakae Kaneko, Hiroyuki Murota, Susumu Murata, Ichiro Katayama, and Eishin Morita Copyright © 2017 Sakae Kaneko et al. All rights reserved. The Evolution of Human Basophil Biology from Neglect towards Understanding of Their Immune Functions Mon, 19 Dec 2016 09:42:45 +0000 Being discovered long ago basophils have been neglected for more than a century. During the past decade evidence emerged that basophils share features of innate and adaptive immunity. Nowadays, basophils are best known for their striking effector role in the allergic reaction. They hence have been used for establishing new diagnostic tests and therapeutic approaches and for characterizing natural and recombinant allergens as well as hypoallergens, which display lower or diminished IgE-binding activity. However, it was a long way from discovery in 1879 until identification of their function in hypersensitivity reactions, including adverse drug reactions. Starting with a historical background, this review highlights the modern view on basophil biology. Markus Steiner, Sara Huber, Andrea Harrer, and Martin Himly Copyright © 2016 Markus Steiner et al. All rights reserved. Prevalence and Clinical Features of Atopic Dermatitis in China Sun, 13 Nov 2016 14:26:25 +0000 Background. The epidemiology of atopic dermatitis (AD) in Chinese outpatients is yet to be clarified. Objectives. To investigate population-based prevalence and clinical features of AD in Chinese outpatients. Methods. A multicenter cross-sectional study was conducted in outpatients with eczema or dermatitis from 39 tertiary hospitals in 15 provinces. Results. This study included 682 patients diagnosed with AD, with the mean age of years and the median course of years. AD patients had more severe itching (30.4% versus 13.8%, ) and clinically suspected bacterial infection (21.7% versus 16.1%, ) than those of other types of dermatitis. Older patients were more susceptible to have a history of flexion dermatitis (), bacterial infection (), and severe itching (). Outpatients with clinically suspected bacterial infection had 3.53-fold increased risk of AD than those without it (). The morbidity rate of AD in the (20–25°N) region is 2.86 times higher than that in the (40–45°N) region [OR (95% CI): 0.352 (0.241–0.514), ]. Conclusions. AD is characterized by unique clinical/demographic features. Bacterial infection and latitude region may have an impact on the incidence of AD in China. Xin Wang, Lin-Feng Li, Da-yu Zhao, and Yi-wei Shen Copyright © 2016 Xin Wang et al. All rights reserved. Strengths, Pitfalls, and Lessons from Longitudinal Childhood Asthma Cohorts of Children Followed Up into Adult Life Mon, 31 Oct 2016 06:37:08 +0000 Asthma is a common problem worldwide and longitudinal studies of children followed up into adult life enable the assessment of clinical outcomes, examine the pattern of lung function outcomes, and importantly provide insight into aetiology and prognosis for patients with asthma. The aim of this review is to examine the major childhood asthma cohort studies which have continued into adult life, describing the strengths and weaknesses and the lessons that can be learnt regarding pathophysiology and potential future directions for research. Andrew Tai Copyright © 2016 Andrew Tai. All rights reserved. How Effective and Safe Is Bronchial Thermoplasty in “Real Life” Asthmatics Compared to Those Enrolled in Randomized Clinical Trials? Thu, 08 Sep 2016 17:38:36 +0000 There is limited information on the efficacy and safety of bronchial thermoplasty (BT) in real life. We evaluated the outcomes of the randomized clinical trials for BT in severe asthmatics, in whom the exclusion criteria were not strictly controlled. A case series of seven asthmatics (M/F: 4/3; age: years) is reported. Subjects had a statistically significant improvement in AQLQ (from a mean of to and after 6 and 12 months of treatment; ) and in the ACQ score (from to and after 6 and 12 months; ). In the year after BT, severe exacerbations, salbutamol use, and OCS use were significantly lower compared with the 1-yr pretreatment period (). No ED visits and hospitalization occurred in the year after BT. No changes in functional parameters were recorded. Our investigation confirms the safety and efficacy of BT in severe asthmatics in real life settings. Rita Arrigo, Giuseppe Failla, Nicola Scichilone, Alba La Sala, Carla Galeone, Salvatore Battaglia, Alida Benfante, and Nicola Facciolongo Copyright © 2016 Rita Arrigo et al. All rights reserved. Importance of Quality of Life for Adherence to Sublingual Immunotherapy Mon, 18 Jul 2016 07:02:00 +0000 Background. Nonperception of efficacy ranks among the most commonly cited causes for nonadherence to sublingual immunotherapy (SLIT). Quality of life (QoL) in patients is a determining factor influencing adherence. We investigated QoL and adherence separately in SLIT patients at one pediatric practice in Germany. Methods. We conducted a noninterventional, cross-sectional, retrospective, quality-of-life survey among pediatric patients treated with SLIT. QoL was assessed using the generic SF-12 health survey in German. The items contained in the SF-12 health survey are weighted, added up, and converted to obtain a physical component score (PCS) and a mental component score (MCS). Each component score ranges from 0 to 100; the higher the score, the better the QoL perceived. Results. 201 surveyed patients who had undergone SLIT showed PCS-12 of 49.3 (± 7.0) and MCS-12 of 52.6 (± 7.2). These figures correlate strongly with those reported for the German general population : PCS-12 of 49.6 (± 8.7) and MCS-12 of 52.3 (± 8.0). 70.2% (73) of 104 patients were adherent at this practice. Conclusions. QoL in the SLIT patients surveyed here appears as good as that of the general population. Adherence to SLIT at this practice was remarkably better than that reported elsewhere. Marie-Luise Lemberg, Peter Eberle, and Kija Shah-Hosseini Copyright © 2016 Marie-Luise Lemberg et al. All rights reserved. Sublingual Immunotherapy: A Useful Tool for the Allergist in Private Practice Tue, 31 May 2016 16:12:48 +0000 This is a review of the author’s experience with Sublingual Immunotherapy in a private office setting. Sublingual Immunotherapy should be considered by any allergy practitioner as a useful tool. Sublingual Immunotherapy is safe while at the same time it is effective. It enables the practitioner to treat asthmatics and young children without the concerns implicit with allergy injections. Diego Saporta Copyright © 2016 Diego Saporta. All rights reserved. Clinical Distinctness of Allergic Rhinitis in Patients with Allergy to Molds Tue, 31 May 2016 16:04:46 +0000 Introduction. Molds are a very diverse group of allergens. Exposure and sensitization to fungal allergens can promote the development and worsening of allergic rhinitis (AR). Objective. The natural course of allergic rhinitis was compared between a group of patients with allergy to molds and patients with AR to other allergens as the control groups. Material and Methods. The study group consisted of 229 patients, with a mean age of  yrs. The study group was compared to groups of AR patients with allergy to house dust mites or pollens or with multivalent allergy. Allergic sensitization was assessed using the skin prick test (SPT) with a panel of 15 allergens to molds and other common inhalant allergens. Specific IgEs against all tested allergens were measured. Nasal fractional exhaled nitric oxide (FeNO) level was assessed with a chemiluminescence analyzer (NIOX MINO) and compared between groups. Cluster analysis was performed for determine models of AR in whole population. Results. Patients with allergy to mold have had AR with a higher blockage of nose than in the patients with other allergies. Alternaria alternata (59% of examined), Cladosporium herbarum (40%), and Aspergillus fumigatus (36%) were the predominant allergens in the study group. Patients with allergy to mold were more often present in two clusters: there were patients with more frequent accompanying asthma and high level of FeNO. Conclusion. Patients with allergy to molds have a significantly greater predisposition for bronchial asthma and high concentration of FeNO. Krzysztof Kołodziejczyk and Andrzej Bozek Copyright © 2016 Krzysztof Kołodziejczyk and Andrzej Bozek. All rights reserved. Lack of Platelet-Activating Factor Receptor Attenuates Experimental Food Allergy but Not Its Metabolic Alterations regarding Adipokine Levels Wed, 25 May 2016 06:35:00 +0000 Platelet-activating factor (PAF) is known to be an important mediator of anaphylaxis. However, there is a lack of information in the literature about the role of PAF in food allergy. The aim of this work was to elucidate the participation of PAF during food allergy development and the consequent adipose tissue inflammation along with its alterations. Our data demonstrated that, both before oral challenge and after 7 days receiving ovalbumin (OVA) diet, OVA-sensitized mice lacking the PAF receptor (PAFR) showed a decreased level of anti-OVA IgE associated with attenuated allergic markers in comparison to wild type (WT) mice. Moreover, there was less body weight and adipose tissue loss in PAFR-deficient mice. However, some features of inflamed adipose tissue presented by sensitized PAFR-deficient and WT mice after oral challenge were similar, such as a higher rate of rolling leukocytes in this tissue and lower circulating levels of adipokines (resistin and adiponectin) in comparison to nonsensitized mice. Therefore, PAF signaling through PAFR is important for the allergic response to OVA but not for the adipokine alterations caused by this inflammatory process. Our work clarifies some effects of PAF during food allergy along with its role on the metabolic consequences of this inflammatory process. Nathália Vieira Batista, Roberta Cristelli Fonseca, Denise Perez, Rafaela Vaz Sousa Pereira, Juliana de Lima Alves, Vanessa Pinho, Ana Maria Caetano Faria, and Denise Carmona Cara Copyright © 2016 Nathália Vieira Batista et al. All rights reserved. No Significant Reduction of Circulating Endothelial-Derived and Platelet-Derived Microparticles in Patients with Psoriasis Successfully Treated with Anti-IL12/23 Sun, 10 Apr 2016 14:12:13 +0000 Psoriasis is associated with atherosclerosis, in which circulating microparticles play an important role. In severe psoriasis, there was an increase of endothelial- and platelet- microparticles which could be decreased by anti-TNFα. However, whether anti-IL-12/23 treatment would decrease the level of microparticles remains unknown. Our study showed that, despite the clinical improvement of psoriasis after IL-12/13 blockage, the increased levels of circulating CD41a and CD31 microparticles were unchanged after anti-IL-12/23. This result suggested that anti-IL12/23 treatment may not alter the development of cardiovascular disease in patients with psoriasis. Ji-Chen Ho, Chih-Hung Lee, and Shang-Hung Lin Copyright © 2016 Ji-Chen Ho et al. All rights reserved. Nonsteroidal Topical Immunomodulators in Allergology and Dermatology Wed, 06 Apr 2016 14:23:25 +0000 The purpose of this study was to review currently available literature data concerning pathomechanisms of action, indications, treatment efficacy, as well as side effects of nonsteroidal immunomodulators used in dermatology, primarily for the treatment of allergic dermatoses. MEDLINE search was undertaken using the key words “Topical Immunomodulators, Dermatology and Allergy”. Full articles, and nothing but full articles, were used. Marina Jovanović and Zoran Golušin Copyright © 2016 Marina Jovanović and Zoran Golušin. All rights reserved. Risk Factors Associated with Irreversible Airway Obstruction in Asthma: A Systematic Review and Meta-Analysis Tue, 29 Mar 2016 14:23:20 +0000 Irreversible airway obstruction (IAO) is a subtype of asthma and relates to poorer prognosis in some asthma patients. However, the prevalence and risk factors for IAO are unknown. A systematic review regarding controlled clinical studies (cohort, case-control studies) on IAO asthma in adult and/or children affected by asthma/early wheeze was performed. Eighteen papers were identified in this study. It was reported that the incidence of IAO at random effects or fixed effects in severe asthma and nonsevere asthma was 0.54 (95% CI: 0.45–0.62) and 0.16 (95% CI: 0.12–0.20), respectively. In IAO asthma, the pooled odds ratio (OR) related to smoking exposure was 2.22 (95% CI: 1.82–2.73), the OR for male, smoking, and fractional exhaled nitric oxide (FENO) was 2.22 (95% CI: 1.82–2.7), 1.79 (95% CI: 1.46–2.19), and 2.16 (95% CI: 1.05–4.43), respectively, suggesting these factors increase the risk of IAO. However, a decreased OR in IAO asthma was observed due to rhinitis (OR = 0.31, 95% CI: 0.24–0.40), atopy (OR = 0.584, 95% CI: 0.466–0.732), and atopic dermatitis (OR = 0.60, 95% CI: 0.42–0.85), indicating these factors are associated with reduced risk of IAO. IAO in asthma is associated with gender, smoking, FENO, rhinitis, atopy, and atopic dermatitis. Lanlan Zhang, Lixiu He, Jin Gong, and Chuntao Liu Copyright © 2016 Lanlan Zhang et al. All rights reserved. Identification and Assessment of the Potential Allergenicity of 7S Vicilins in Olive (Olea europaea L.) Seeds Mon, 29 Feb 2016 17:10:04 +0000 Olive seeds, which are a raw material of interest, have been reported to contain 11S seed storage proteins (SSPs). However, the presence of SSPs such as 7S vicilins has not been studied. In this study, following a search in the olive seed transcriptome, 58 sequences corresponding to 7S vicilins were retrieved. A partial sequence was amplified by PCR from olive seed cDNA and subjected to phylogenetic analysis with other sequences. Structural analysis showed that olive 7S vicilin contains 9 -helixes and 22 -sheets. Additionally, 3D structural analysis displayed good superimposition with vicilin models generated from Pistacia and Sesamum. In order to assess potential allergenicity, T and B epitopes present in these proteins were identified by bioinformatic approaches. Different motifs were observed among the species, as well as some species-specific motifs. Finally, expression analysis of vicilins was carried out in protein extracts obtained from seeds of different species, including the olive. Noticeable bands were observed for all species in the 15–75 kDa MW interval, which were compatible with vicilins. The reactivity of the extracts to sera from patients allergic to nuts was also analysed. The findings with regard to the potential use of olive seed as food are discussed. Jose C. Jimenez-Lopez, Adoración Zafra, Lucía Palanco, José Fernando Florido, and Juan de Dios Alché Copyright © 2016 Jose C. Jimenez-Lopez et al. All rights reserved. Sandwich Enzyme-Linked Immunosorbent Assay for Detecting Sesame Seed in Foods Wed, 09 Dec 2015 14:26:48 +0000 Small amounts of sesame can trigger allergic reactions in sesame-allergic patients. Because sesame is a widely used food ingredient, analytical methods are needed to support quality control and food safety programs in the food industry. In this study, polyclonal antibodies against sesame seed proteins were raised, and an enzyme-linked immunosorbent assay (ELISA) was developed for the detection and quantification of sesame seed residue in food. A comparison was made between this ELISA and other assays, particularly focusing on recovery of sesame seed residue from different food matrices. The developed ELISA is sensitive with a lower limit of quantification of 0.5 ppm and shows essentially no cross-reactivity with other foods or food ingredients (92 tested). The ELISA has a good recovery for analyzing sesame-based tahini in peanut butter, outperforming one other test. In a baked bread matrix, the ELISA has a low recovery, while two other assays perform better. We conclude that a sensitive and specific ELISA can be constructed based on polyclonal antibodies, which is suitable for detection of small amounts of sesame seed relevant for highly allergic patients. Furthermore, we conclude that different food products may require different assays to ensure adequate quantification of sesame. Stef J. Koppelman, Gülsen Söylemez, Lynn Niemann, Ferdelie E. Gaskin, Joseph L. Baumert, and Steve L. Taylor Copyright © 2015 Stef J. Koppelman et al. All rights reserved. Association between Micronutrient Levels and Chronic Spontaneous Urticaria Thu, 22 Oct 2015 09:14:01 +0000 Previous reports have suggested a possible role for vitamin D in the etiology of chronic spontaneous urticaria (CSU); however, little information is available regarding the role of other micronutrients. We, therefore, analyzed vitamin D, vitamin B12, and ferritin levels in CSU patients () from a preexisting database at Southampton General Hospital. Data were compared against mean micronutrient levels of the general population of the UK, obtained from the National Diet and Nutrition Survey. Vitamin D levels of CSU patients were found to be higher than those of the general UK population (). B12 levels were lower in patients with CSU () than in the general population. Ferritin levels were found to be lower in male CSU patients than in the general male population (). This association between low B12 and iron levels and CSU might indicate a causal link, with micronutrient replacement as a potential therapeutic option. Cheng-Han Wu, Efrem Eren, Michael Roger Ardern-Jones, and Carina Venter Copyright © 2015 Cheng-Han Wu et al. All rights reserved. Tropomyosin and Actin Identified as Major Allergens of the Carpet Clam (Paphia textile) and the Effect of Cooking on Their Allergenicity Thu, 27 Aug 2015 11:50:27 +0000 Objectives. To identify the major allergenic proteins of clam (Paphia textile) and to investigate the effect of different cooking methods on the allergenicity of these identified proteins. Methods. Clam protein extracts were separated by denaturing polyacrylamide gel electrophoresis. IgE reactive proteins were then analyzed by immunoblotting with sera from patients with positive skin prick tests (SPT) to the raw clam extract. Mass spectrometry was used to identify the major allergenic proteins of this clam. Results. Raw extract showed 12 protein bands (18–150 kDa). In contrast, fewer protein bands were seen in the boiled extract; those ranging from 40 to 150 kDa were denatured. The protein profiles were similarly altered by frying or roasting. The immunoblots of raw and boiled extracts yielded 10 and 2 IgE-binding proteins, respectively. The fried and roasted extracts showed only a single IgE-binding protein at 37 kDa. Mass spectrometry analysis of the 37 and 42 kDa major allergens indicated that these spots were tropomyosin and actin, respectively. Conclusion. The two major allergens of Paphia textile were identified as the thermostable tropomyosin and a new thermolabile allergen actin. Zailatul Hani Mohamad Yadzir, Rosmilah Misnan, Faizal Bakhtiar, Noormalin Abdullah, and Shahnaz Murad Copyright © 2015 Zailatul Hani Mohamad Yadzir et al. All rights reserved. Sublingual Immunotherapy with a Five-Grass Pollen Tablet in Adult Patients with Allergic Rhinitis: An Open, Prospective, Noninterventional, Multicenter Study Sun, 16 Aug 2015 14:05:27 +0000 Background. Although the safety and efficacy of sublingual immunotherapy (SLIT) with a five-grass pollen tablet have been demonstrated in randomized clinical trials (RCTs), these outcomes must always be evaluated in real-life medical practice. Methods. In a prospective, open-label, noninterventional, “real-life” study in Germany, we evaluated the safety, tolerability, and effectiveness of SLIT with a five-grass pollen tablet in adults with grass-pollen-induced allergic rhinoconjunctivitis. Results. 808 adults were enrolled between September 2008 and December 2009. 35.3% of the participants experienced at least one adverse drug reaction (ADR), the most common of which were mild-to-moderate gastrointestinal and respiratory disorders. Serious ADRs considered causally related to SLIT treatment occurred in four patients. Overall, the five-grass pollen tablet was considered to have good or very good tolerability by most investigators and patients. Treatment was associated with the relief of nasal, ocular, and bronchial symptoms and decreased symptomatic medication use. However, interpretation of clinical improvements was limited by lower atmospheric grass pollen levels during the study season (relative to the preceding season). Conclusions. In a large population of patients treated in real-life medical practice, SLIT with a five-grass pollen tablet was safe and well tolerated. The patient-reported symptom relief suggests that SLIT was associated with clinical benefits. Oliver Pfaar, Heinz-Gerd Richter, Ludger Klimek, Jochen Sieber, Meike Hadler, and Efstrathios Karagiannis Copyright © 2015 Oliver Pfaar et al. All rights reserved. The Step Further to Understand the Role of Cytosolic Phospholipase A2 Alpha and Group X Secretory Phospholipase A2 in Allergic Inflammation: Pilot Study Wed, 27 Aug 2014 07:51:50 +0000 Allergens, viral, and bacterial infections are responsible for asthma exacerbations that occur with progression of airway inflammation. cPLA2α and sPLA2X are responsible for delivery of arachidonic acid for production of eicosanoids—one of the key mediators of airway inflammation. However, cPLA2α and sPLA2X role in allergic inflammation has not been fully elucidated. The aim of this study was to analyze the influence of rDer p1 and rFel d1 and lipopolysaccharide (LPS) on cPLA2α expression and sPLA2X secretion in PBMC of asthmatics and in A549 cell line. PBMC isolated from 14 subjects, as well as A549 cells, were stimulated with rDer p1, rFel d1, and LPS. Immunoblotting technique was used to study the changes in cPLA2α protein expression and ELISA was used to analyze the release of sPLA2X. PBMC of asthmatics released more sPLA2X than those from healthy controls in the steady state. rDer p1 induced more sPLA2X secretion than cPLA2α protein expression. rFel d1 caused decrease in cPLA2α relative expression in PBMC of asthmatics and in A549 cells. Summarizing, Der p1 and Fel d1 involve phospholipase A2 enzymes in their action. sPLA2X seems to be one of important PLA2 isoform in allergic inflammation, especially caused by house dust mite allergens. Ewa Pniewska, Milena Sokolowska, Izabela Kupryś-Lipińska, Monika Przybek, Piotr Kuna, and Rafal Pawliczak Copyright © 2014 Ewa Pniewska et al. All rights reserved. Connexin 43 Expression on Peripheral Blood Eosinophils: Role of Gap Junctions in Transendothelial Migration Sun, 06 Jul 2014 07:35:46 +0000 Eosinophils circulate in the blood and are recruited in tissues during allergic inflammation. Gap junctions mediate direct communication between adjacent cells and may represent a new way of communication between immune cells distinct from communication through cytokines and chemokines. We characterized the expression of connexin (Cx)43 by eosinophils isolated from atopic individuals using RT-PCR, Western blotting, and confocal microscopy and studied the biological functions of gap junctions on eosinophils. The formation of functional gap junctions was evaluated measuring dye transfer using flow cytometry. The role of gap junctions on eosinophil transendothelial migration was studied using the inhibitor 18-a-glycyrrhetinic acid. Peripheral blood eosinophils express Cx43 mRNA and protein. Cx43 is localized not only in the cytoplasm but also on the plasma membrane. The membrane impermeable dye BCECF transferred from eosinophils to epithelial or endothelial cells following coculture in a dose and time dependent fashion. The gap junction inhibitors 18-a-glycyrrhetinic acid and octanol did not have a significant effect on dye transfer but reduced dye exit from eosinophils. The gap junction inhibitor 18-a-glycyrrhetinic acid inhibited eosinophil transendothelial migration in a dose dependent manner. Thus, eosinophils from atopic individuals express Cx43 constitutively and Cx43 may play an important role in eosinophil transendothelial migration and function in sites of inflammation. Harissios Vliagoftis, Cory Ebeling, Ramses Ilarraza, Salahaddin Mahmudi-Azer, Melanie Abel, Darryl Adamko, A. Dean Befus, and Redwan Moqbel Copyright © 2014 Harissios Vliagoftis et al. All rights reserved. Exercise Training, Lymphocyte Subsets and Their Cytokines Production: Experience of an Italian Professional Football Team and Their Impact on Allergy Mon, 23 Jun 2014 13:06:24 +0000 Background. In recent years, numerous articles have attempted to shed light on our understanding of the pathophysiological mechanisms of exercise-induced immunologic changes and their impact on allergy and asthma. It is known that lymphocyte subclasses, cytokines, and chemokines show modifications after exercise, but outcomes can be affected by the type of exercise as well as by its intensity and duration. Interesting data have been presented in many recent studies on mouse models, but few studies on humans have been performed to check the long-term effects of exercise over a whole championship season. Methods. This study evaluated lymphocyte subsets and their intracellular IL-2, IL-4, TNF-α, and IFN-γ production in professional football (soccer) players, at three stages of the season, to evaluate if alterations occur, particularly in relation to their allergic status. Results and Conclusion. Despite significant mid-season alterations, no significant lymphocyte subclasses count modifications, except for NKs that were significantly higher, were observed at the end. IL-2 and IL-4 producing cells showed a significant decrease ( and , but in a steady fashion for IL-4), confirming the murine data about the potential beneficial effects of aerobic exercise for allergic asthma. Stefano R. Del Giacco, Marco Scorcu, Federico Argiolas, Davide Firinu, and G. Sergio Del Giacco Copyright © 2014 Stefano R. Del Giacco et al. All rights reserved. The Association between Platelet Count and Acute Phase Response in Chronic Spontaneous Urticaria Mon, 16 Jun 2014 08:34:27 +0000 Background. The platelet parameters and C-reactive protein (CRP) are markers reflecting a systemic inflammatory response. Among those, CRP is one of the major proteins helpful in determination of severity/activity of chronic spontaneous urticaria (CSU). Aim. To determine relationships between platelet activation indices and serum concentration of CRP, the best marker of acute phase response, and their potential clinical use in CSU patients. Methods. Mean platelet volume (MPV), platelet distribution width (PDW), and platelet count as well as serum CRP concentration were measured in CSU patients, showing different degrees of urticarial severity, and in the healthy subjects. Results. No significant differences were found in MPV and PDW between CSU group and the healthy subjects. The platelet count was significantly higher in moderate-severe CSU than that of the controls and mild CSU patients. Serum CRP concentrations were significantly higher in CSU patients as compared with the healthy subjects and significantly correlated with the platelet count in CSU patients. Conclusions. Acute phase response in CSU is associated with the increased number of circulating platelets in patients with more severe symptoms. It seems that simple determination of platelet size indices is not a reliable indicator of CSU severity/activity. Alicja Kasperska-Zając, Alicja Grzanka, Jerzy Jarzab, Maciej Misiołek, Magdalena Wyszyńska-Chłap, Jacek Kasperski, and Edyta Machura Copyright © 2014 Alicja Kasperska-Zając et al. All rights reserved. Fraction of Exhaled Nitric Oxide (FeNO) Norms in Healthy Tunisian Adults Tue, 03 Jun 2014 11:53:58 +0000 Aims. To establish FeNO norms for healthy Tunisian adults aged 18–60 years and to prospectively assess their reliability. Methods. This was a cross-sectional analytical study. A convenience sample of healthy Tunisian adults was recruited. Subjects responded to a medical questionnaire, and then FeNO levels were measured by an online method (Medisoft, Sorinnes (Dinant), Belgium). Clinical, anthropometric, and plethysmographic data were collected. All analyses were performed on natural logarithm values of FeNO. Results. 257 adults (145 males) were retained. The proposed reference equation to predict FeNO value is lnFeNO (ppb) = 3.47−0.56× height (m). After the predicted FeNO value for a given adult was computed, the upper limit of normal could be obtained by adding 0.60 ppb. The mean ± SD (minimum-maximum) of FeNO (ppb) for the total sample was (5.00–26.00). For Tunisian and Arab adults of any age and height, any FeNO value greater than 26.00 ppb may be considered abnormal. Finally, in an additional group of adults prospectively assessed, we found no adult with a FeNO higher than 26.00 ppb. Conclusion. The present FeNO norms enrich the global repository of FeNO norms that the clinician can use to choose the most appropriate norms. Sonia Rouatbi, Mohamed Ali Chouchene, Ines Sfaxi, Mohamed Ben Rejeb, Zouhair Tabka, and Helmi Ben Saad Copyright © 2014 Sonia Rouatbi et al. All rights reserved. Downregulation of Angiogenesis Factors, VEGF and PDGF, after Rapid IgE Desensitization and Oral Immunotherapy in Children with Food Allergy Tue, 03 Jun 2014 06:35:58 +0000 Background. Angiogenesis has a key role in several conditions and is regulated by several factors such as the platelet-derived growth factor (PDGF) or the vascular endothelial growth factor (VEGF). The goal of this study was to investigate the possible role of PDGF and VEGF in a group of patients with severe food allergy. Methods. We design a prospective longitudinal study () with patients with persistent cow’s milk proteins (CMP) allergy. After achieving a CMP rush desensitization protocol, a clinical followup including SPT and blood samples to determine sIgE, protein levels, PDGF, and VEGF-A and a panel of the most representative Th1, Th2, Treg, and Th17 cytokines were also monitored. Results. Baseline levels of PDGF and VEGF in the CMP allergic patients (1170 pg/mL and 253 pg/mL) were different compared to those nonallergic CMP control subjects (501 pg/mL and 108 pg/mL). Both PDGF and VEGF were significantly downregulated () 6 months after completion of the CMP desensitization process and remained significantly decreased 12 months later. Conclusion. The present study shows a significant increase of PDGF and VEGF in anaphylaxis suffering children compared to a control group. Interestingly, both VEGF and PDGF were significantly downregulated after completing a full CMP rush IgE desensitization. Paloma Poza-Guedes, Yvelise Barrios, Victoria Fuentes, Andres Franco, Inmaculada Sánchez-Machín, Elena Alonso, Ruperto González Pérez, Sonsoles Infante, Lydia Zapatero, and Víctor Matheu Copyright © 2014 Paloma Poza-Guedes et al. All rights reserved. IL-33 Enhanced the Proliferation and Constitutive Production of IL-13 and IL-5 by Fibrocytes Sun, 13 Apr 2014 13:10:48 +0000 Interleukin-33 appears to play important roles in the induction of allergic airway inflammation. However, whether IL-33 is involved in airway remodeling remains unclear. Because fibrocytes contribute to tissue remodeling in the setting of chronic inflammation, we examined the effects of IL-33 on fibrocyte functions. Fibrocytes were generated in vitro from peripheral blood mononuclear cells by culturing in the presence of platelet derived growth factors and the cells were stimulated with IL-33. IL-33 enhanced cell proliferation, -SMA expression, and pro-MMP-9 activity by the fibrocytes without increasing endogenous transforming growth factor-1 production. Fibrocytes constitutively expressed IL-13 and IL-5, and their production was augmented by stimulation with IL-33. Dexamethasone inhibited the functions of fibrocytes, but IL-33 made fibrocytes slightly refractory to the inhibitory effect of dexamethasone in terms of IL-13 production. Montelukast suppressed IL-13 production by nonstimulated fibrocytes but not those stimulated by IL-33. These findings suggest that IL-33 is involved in the airway remodeling process through its modulation of fibrocyte function independent of antigen stimulation. IL-33 might partially reduce the therapeutic effects of glucocorticoid and cysteinyl leukotriene receptor antagonist on fibrocyte-mediated Th2 responses. Hisako Hayashi, Akiko Kawakita, Shintaro Okazaki, Hiroki Murai, Motoko Yasutomi, and Yusei Ohshima Copyright © 2014 Hisako Hayashi et al. All rights reserved. Safety and Efficacy of Tree Pollen Specific Immunotherapy on the Ultrarush Administration Schedule Method Using Purethal Trees Mon, 24 Mar 2014 08:22:59 +0000 Background. Specific immunotherapy (SIT) with an ultrarush administration schedule with Purethal for tree pollen allergens has been evaluated to assess its efficacy and safety. Methods. The study group consisted of 22 patients with symptoms of allergic rhinitis and confirmed allergy to tree pollens. Patients were randomized and given an administration schedule of either ultrarush therapy or conventional preseasonal SIT. Treatment was performed during three consecutive years. Results. After three years of treatment, a similar reduction in nasal symptoms was observed; according to the visual analog scale, there was a decrease from 3.991 ± 0.804 points to 1.634 ± 0.540 in the ultrarush group and from 3.845 ± 0.265 to 1.501 ± 0.418 in the group desensitized using the conventional method (). There was also a comparable reduction in the use of relief drugs during pollen season and an increase in the serum concentration of IgG4 to tree pollens. No significant differences in the safety profile were observed. Conclusion. An administration schedule of ultrarush SIT with Purethal Trees is a safe treatment in preliminary observations. This therapy is comparable with conventional administration of SIT in the field of efficacy and safety. Andrzej Bozek, Krzysztof Kolodziejczyk, and Jerzy Jarzab Copyright © 2014 Andrzej Bozek et al. All rights reserved. Interleukin 1-β, Interleukin-1 Receptor Antagonist, and Interleukin 18 in Children with Acute Spontaneous Urticaria Sun, 29 Dec 2013 09:11:58 +0000 Very little is known about the role of interleukin-1β (IL-1β) and interleukin-18 (IL-18) in urticaria. Material and Methods. Serum levels of IL-1β, IL-1 receptor antagonist (IL-1RA), and IL-18 were measured in 56 children with urticaria and in 41 healthy subjects. Results. Serum IL-1β did not differ between children with acute urticaria and controls. Children with single episode of urticaria had higher levels of IL-1RA and IL-18 than healthy subjects. In children with single episode of urticaria, level of IL-1RA correlated with C-reactive protein (CRP), D-dimer, and IL-1β levels. In subjects with recurrence of urticaria IL-1RA was positively correlated with WBC and D-dimer levels. No correlation of cytokine levels and urticaria severity scores (UAS) in all children with urticaria was observed. In children with single episode of urticaria UAS correlated with CRP level. In the group with single episode of urticaria and in children with symptoms of upper respiratory infection, IL-1RA and IL-18 levels were higher than in controls. The former was higher than in noninfected children with urticaria. In conclusion, this preliminary study documents that serum IL-1RA and IL-18 levels are increased in some children with acute urticaria. However further studies are necessary to define a pathogenic role of IL-1β, IL-1RA, and IL-18 in urticaria. E. Machura, M. Szczepańska, B. Mazur, M. Barć-Czarnecka, and A. Kasperska-Zając Copyright © 2013 E. Machura et al. All rights reserved. Peanut Sensitization Profiles in Italian Children and Adolescents with Specific IgE to Peanuts Thu, 14 Nov 2013 13:58:02 +0000 Peanuts are one of the most relevant foods implicated in IgE-mediated adverse reactions in pediatric population. This study aimed to evaluate the pattern of sensitization towards five peanut allergenic components (rAra h 1, 2, 3, 8 and 9) in a population of Italian children and adolescents with specific IgE (sIgE) to peanut. rAra h 9 was the main allergen implicated in peanut sensitization (58%), followed by rAra h 8 (35%), rAra h 2 (27%), rAra h 3 (23%) and rAra h 1 (12.5%). rAra h 1, 2, and 3 were the main allergenic components in young children: 8/13 (62%) between 2 and 5 years, 8/23 (35%) between 6 and 11 years, and 3/12 (25%) between 1 and 16 years. No differences were found among the levels of sIgE towards rAra h 1, 2, 3, and 9 in the three groups; in contrast, the levels of sIgE against rAra h 8 showed an increasing trend according to age. In conclusion rAra h 1, 2, and 3 were the prevalent sensitizing allergens during the first years of life in Italian patients with sIgE to peanuts (“genuine” allergy); in contrast rAra h 9 and 8 were mainly involved in school-age children and adolescents with pollen allergy (“secondary” sensitization). Elisabetta Calamelli, Carlo Caffarelli, and Giampaolo Ricci Copyright © 2013 Elisabetta Calamelli et al. All rights reserved. Occupational Allergic Diseases in Kitchen and Health Care Workers: An Underestimated Health Issue Mon, 11 Nov 2013 09:08:27 +0000 Objective. This study evaluated the frequencies of allergic symptoms and rate of upper respiratory infections during the past year in the general population, kitchen workers (KW) and health care workers (HCW). Methods. The European Community Respiratory Health Survey (ECRHS) was used to inquire retrospectively about asthma and asthma-like symptoms and the number of treatments required for previous upper respiratory tract infections (URTI: acute pharyngitis, acute sinusitis, etc.) during the past year for health care workers, kitchen workers, and members of the general population. Adjusted odds ratios by gender, age, and smoking status were calculated. Results. 579 subjects (186 from the general population, 205 KW, and 188 HCW; 263 females, 316 males) participated in the study. Noninfectious (allergic) rhinitis was significantly higher in the HCW and KW groups than in the general population (). Cumulative asthma was significantly higher only in the HCW group (). In addition, the HCW and KW groups had significantly higher risks of ≥2/year URTI (OR: 1.59, 95% CI: 1.07–2.38 versus OR: 1.57, 95% CI: 1.05–2.38) than the general population. Conclusion. Occupational allergic respiratory diseases are an important and growing health issue. Health care providers should become familiar with workplace environments and environmental causes of occupational rhinitis and asthma. Ugur Bilge, Ilhami Unluoglu, Nazan Son, Ahmet Keskin, Yasemin Korkut, and Murat Unalacak Copyright © 2013 Ugur Bilge et al. All rights reserved. Is Delayed Pressure Urticaria Associated with Increased Systemic Release of sCD40L? Wed, 23 Oct 2013 13:05:29 +0000 Background. Elevated levels of soluble CD40 Ligand (sCD40L) were found in serum but not in plasma of patients with chronic spontaneous urticaria (CU). What is important is that sCD40L has proinflammatory properties, and its elevated plasma level may indicate increased risk of cardiovascular events. These observations should stimulate further evaluation of sCD40L in different forms of urticaria. Aim. In the present study, sCD40L plasma level was investigated in delayed pressure urticaria (DPU). Methods. As platelets are predominant and variable sources of sCD40L, we investigated sCD40L concentration in platelet-poor plasma (PPP), which seems the best way to minimize the potential contribution of these cells to the ligand level. Results. Plasma sCD40L concentration was significantly increased in the DPU group compared to the healthy controls. Conclusions. It seems that DPU is associated with increased systemic release of sCD40L, which is believed to derive predominantly from activated platelets. The present study as well as the earlier contributions suggest that distinct cells activity, including platelets, may be identified in different types of urticaria. T. Jasinska, A. Grzanka, E. Machura, and A. Kasperska-Zajac Copyright © 2013 T. Jasinska et al. All rights reserved. Depigmented Allergoids Reveal New Epitopes with Capacity to Induce IgG Blocking Antibodies Tue, 08 Oct 2013 10:26:44 +0000 Background. The synthesis of allergen-specific blocking IgGs that interact with IgE after allergen immunotherapy (SIT) has been related to clinical efficacy. The objectives were to investigate the epitope specificity of IgG-antibodies induced by depigmented-polymerized (Dpg-Pol) allergoids and unmodified allergen extracts, and examine IgE-blocking activity of induced IgG-antibodies. Methods. Rabbits were immunized with native and Dpg-Pol extracts of birch pollen, and serum samples were obtained. Recognition of linear IgG-epitopes of Bet v 1 and Bet v 2 and the capacity of these IgG-antibodies to block binding of human-IgE was determined. Results. Serum from rabbits immunized with native extracts recognised 11 linear epitopes from Bet v 1, while that from Dpg-Pol-immunized animals recognised 8. For Bet v 2, 8 epitopes were recognized by IgG from native immunized animals, and 9 from Dpg-Pol immunized one. Dpg-Pol and native immunized serum did not always recognise the same epitopes, but specific-IgG from both could block human-IgE binding sites for native extract. Conclusions. Depigmented-polymerized birch extract stimulates the synthesis of specific IgG-antibodies which recognize common but also novel epitopes compared with native extracts. IgG-antibodies induced by Dpg-Pol effectively inhibit human-IgE binding to allergens which may be part of the mechanism of action of SIT. M. Angeles López-Matas, Mayte Gallego, Víctor Iraola, Douglas Robinson, and Jerónimo Carnés Copyright © 2013 M. Angeles López-Matas et al. All rights reserved. The Fold Variant BM4 Is Beneficial in a Therapeutic Bet v 1 Mouse Model Mon, 23 Sep 2013 08:30:30 +0000 Background. Specific immunotherapy using recombinant allergens is clinically effective; still wild-type allergens can provoke treatment-induced side effects and often show poor immunogenicity in vivo. Thus, we tested the low IgE-binding, highly immunogenic fold variant BM4 in a Bet v 1 mouse model. Methods. Recombinant BM4 was used as active vaccine ingredient to treat mice sensitized to Bet v 1. As controls, mice were treated with either Bet v 1 or sham, and the humoral as well as cellular immune response was monitored. Moreover, lung function and lung inflammation were analysed. Results. BM4 was more effective than wild-type Bet v 1 in inducing Bet v 1-specific blocking antibodies as well as IFN-γ and IL-10 producing T cells. Further, birch pollen induced lung inflammation could be ameliorated significantly by BM4 treatment as demonstrated by a reduction of airway hyperresponsiveness and drastically decreased eosinophil counts in bronchoalveolar lavage fluids. Conclusion. The study outlines the high potential of BM4 as vaccine candidate for the treatment of Bet v 1-mediated birch pollen allergies. Ulrike Pichler, Claudia Asam, Richard Weiss, Almedina Isakovic, Michael Hauser, Peter Briza, Fatima Ferreira, and Michael Wallner Copyright © 2013 Ulrike Pichler et al. All rights reserved. IgE Sensitization to the Nonspecific Lipid-Transfer Protein Ara h 9 and Peanut-Associated Bronchospasm Thu, 12 Sep 2013 08:54:24 +0000 Allergen component analysis is now available in many laboratories. The aim of this study was to examine the possible association between peanut allergen IgE components and severity of clinical reactions in patients with a history of peanut allergy. Data and sera collected from 192 patients within the Manchester Allergy Research Database and Serum Bank were used in this retrospective study. Sensitization to peanut specific IgE and Ara h 1, 2, 3, and 8 peanut IgE components, as measured by fluoroenzyme immunoassay, was not associated with anaphylaxis. In contrast, sensitization to the lipid-transfer protein Ara h 9 was significantly more prevalent in patients with peanut-associated bronchospasm (26% versus 9% of patients), even after adjusting for potential confounding effects of age, gender, and severity of concomitant chronic atopic diseases. Patients who were sensitized to Ara h 9 were more likely to have ingested rather than just have had skin contact with peanut and have a more rapid onset of symptoms. These results are consistent with observations that sensitization to heat and protease resistant lipid-transfer protein components of hazelnut, grains, and fruit is predictive of anaphylaxis. Peter D. Arkwright, Colin W. Summers, Beverley J. Riley, Najla Alsediq, and Richard S. H. Pumphrey Copyright © 2013 Peter D. Arkwright et al. All rights reserved. Allergy or Tolerance: Reduced Inflammatory Cytokine Response and Concomitant IL-10 Production of Lymphocytes and Monocytes in Symptom-Free Titanium Dental Implant Patients Wed, 11 Sep 2013 11:07:42 +0000 Hypersensitivity reactions to titanium (Ti) are very rare. Thus, we assessed the proinflammatory response and also potential tolerance favoring in vitro reactivity of human blood lymphocytes and monocytes (PBMC) to Ti in healthy individuals (14 without, 6 with complication-free dental Ti implants). The proliferation index (SI) in lymphocyte transformation test (LTT) and production of cytokines linked to innate immune response (IL-1β, IL-6, and TNFα) or immune regulation (IL-10) were assessed in response to TiO2 particles or Ti discs. In both groups, the Ti-LTT reactivity was not enhanced (e.g., ). The control antigen tetanus toxoid (TT) gave adequate reactivity (median SI individuals without/with implant: /). Individuals without implant showed higher cytokine response to Ti materials than individuals with symptom-free implants; for example, TiO2 rutile particle induced increase of IL-1β 70.27-fold/8.49-fold versus control medium culture. PBMC of 5 of the 6 individuals with complication-free Ti implants showed an ex vivo ongoing production of IL-10 (mean  pg/mL)-but none of the 14 controls showed such IL-10 production. Thus in vitro IL-1β-, IL-6-, and TNF-α production reflects “normal” unspecific immune response to Ti. This might be reduced by production of tolerogenic IL-10 in individuals with symptom-free Ti dental implants. Peter Thomas, Gerhard Iglhaut, Andreas Wollenberg, Dieter Cadosch, and Burkhard Summer Copyright © 2013 Peter Thomas et al. All rights reserved. Is Health-Related Quality of Life Associated with Upper and Lower Airway Inflammation in Asthmatics? Sat, 31 Aug 2013 12:35:06 +0000 Background. Allergic diseases impair health-related quality of life (HR-QoL). However, the relationship between airway inflammation and HR-QoL in patients with asthma and rhinitis has not been fully investigated. We explored whether the inflammation of upper and lower airways is associated with HR-QoL. Methods. Twenty-two mild allergic asthmatics with concomitant rhinitis (10 males, 38 ± 17 years) were recruited. The Rhinasthma was used to identify HR-QoL, and the Asthma Control Test (ACT) was used to assess asthma control. Subjects underwent lung function and exhaled nitric oxide (eNO) test, collection of exhaled breath condensate (EBC), and nasal wash. Results. The Rhinasthma Global Summary score (GS) was 25 ± 11. No relationships were found between GS and markers of nasal allergic inflammation (% eosinophils: , ; ECP: , ) or bronchial inflammation (pH of the EBC: , ; bronchial NO: , ; alveolar NO: , ). The mean ACT score was 18. When subjects were divided into controlled (ACT ≥ 20) and uncontrolled (ACT < 20), the alveolar NO significantly correlated with GS in uncontrolled asthmatics (, ). Conclusions. Upper and lower airways inflammation appears unrelated to HR-QoL associated with respiratory symptoms. These preliminary findings suggest that, in uncontrolled asthma, peripheral airway inflammation could be responsible for impaired HR-QoL. Nicola Scichilone, Fulvio Braido, Salvatore Taormina, Elena Pozzecco, Alessandra Paternò, Ilaria Baiardini, Vincenzo Casolaro, Giorgio Walter Canonica, and Vincenzo Bellia Copyright © 2013 Nicola Scichilone et al. All rights reserved. Distal Airway Impairment in Obese Normoreactive Women Tue, 27 Aug 2013 08:57:26 +0000 Background. Asthma-like symptoms are frequent in overweight and obesity, but the mechanism is unclear when airway hyperresponsiveness (AHR) is lacking. In this study, we focused on obese women with a clinical suspicion of asthma but negative methacholine challenge and tested distal airway hyperreactivity, explored by Forced Vital Capacity dose-response slope (FVC DRS). Objective. To question AHR at the distal airway level in obese women. Methods. A total of 293 symptomatic obese and nonobese women free of treatment were investigated. Methacholine challenge tests were undertaken, and patients were divided according to their results to the test. In hyperreactive and nonhyperreactive patients and in our total population, correlations, regression analyses, and analyses of covariance were performed to compare distal airway hyperreactivity in three groups of body mass index (BMI). Results. After adjusting for age and baseline respiratory values, the relationship between FVC and FEV1 (forced expiratory volume in one second) DRS was influenced by BMI, with a lower slope in obese than overweight and normal patients in our total population () and in our nonhyperreactive one (). Conclusion. Distal airway hyperresponsiveness was observed in symptomatic wheezing obese women negative to methacholine challenge. Grégory Marin, Anne Sophie Gamez, Nicolas Molinari, Djamila Kacimi, Isabelle Vachier, Fabrice Paganin, Pascal Chanez, and Arnaud Bourdin Copyright © 2013 Grégory Marin et al. All rights reserved. The Impact of Aspergillus fumigatus Viability and Sensitization to Its Allergens on the Murine Allergic Asthma Phenotype Mon, 26 Aug 2013 14:03:02 +0000 Aspergillus fumigatus is a ubiquitously present respiratory pathogen. The outcome of a pulmonary disease may vary significantly with fungal viability and host immune status. Our objective in this study was (1) to assess the ability of inhaled irradiation-killed or live A. fumigatus spores to induce allergic pulmonary disease and (2) to assess the extent to which inhaled dead or live A. fumigatus spores influence pulmonary symptoms in a previously established allergic state. Our newly developed fungal delivery apparatus allowed us to recapitulate human exposure through repeated inhalation of dry fungal spores in an animal model. We found that live A. fumigatus spore inhalation led to a significantly increased humoral response, pulmonary inflammation, and airway remodeling in naïve mice and is more likely to induce allergic asthma symptoms than the dead spores. In contrast, in allergic mice, inhalation of dead and live conidia recruited neutrophils and induced goblet cell metaplasia. This data suggests that asthma symptoms might be exacerbated by the inhalation of live or dead spores in individuals with established allergy to fungal antigens, although the extent of symptoms was less with dead spores. These results are likely to be important while considering fungal exposure assessment methods and for making informed therapeutic decisions for mold-associated diseases. Sumali Pandey, Scott A. Hoselton, and Jane M. Schuh Copyright © 2013 Sumali Pandey et al. All rights reserved. Characteristics of Atopic Bronchial Asthma in Seniors over 80 Years of Age Wed, 31 Jul 2013 09:05:24 +0000 Background. Asthma in the elderly is an important public health problem. The aim of this study was to assess the prevalence and characteristics of asthma in seniors. Materials and Methods. The study involved 105 people of at least 80 years of age (mean age of 84.1 ± 3.9 years) selected from a group of 1860 individuals. Spirometry, the methacholine test, allergy diagnosis, a measurement of exhaled nitric oxide, and administration of the asthma quality of life questionnaire (AQLQ) were performed. Results. The average morbidity of asthma in the study population of elderly people (at least 80 years of age) was 5.6% (105 people) of the confidence interval (95% CI: 5.1–6.0). In the study group, 34% of the elderly asthmatics had uncontrolled asthma, 47% had partly controlled asthma, and only 24% had fully controlled asthma. Allergy to house dust mites was predominant. The average total score on the AQLQ was 4.12 ± 0.72 (arithmetic mean ± standard deviation) for the seniors, which was significantly lower than the score for the young. Conclusion. The pathogenesis, natural history, and value of the basic diagnostic methods of asthma in the elderly are similar to those observed in younger age groups. Andrzej Bożek, Marek Filipowski, Andreas Fischer, and Jerzy Jarzab Copyright © 2013 Andrzej Bożek et al. All rights reserved. The Efficacy of Allergen Immunotherapy with Cat Dander in Reducing Symptoms in Clinical Practice Wed, 31 Jul 2013 07:53:22 +0000 Background. Allergy to cat dander is a common form of allergic disease. Allergen immunotherapy has been demonstrated to be effective in decreasing allergic symptoms. Objectives. To examine outcomes in allergic asthmatic patients on cat immunotherapy (CIT) compared to allergic asthmatics on traditional immunotherapy (IT) without cat sensitivity. Methods. A retrospective review identified allergic asthmatics on CIT for at least three years. An equal number of allergic asthmatics on IT were identified for comparison. Outcomes investigated include measurements of risk of asthma exacerbation. Results. Thirty-five patients were identified in each group. There were no differences in the CIT group versus the comparison group regarding total number of prednisone tapers (18 tapers versus 14 tapers, resp.), number of patients requiring prednisone tapers (10 patients versus 10 patients, resp.), total number of acute visits (29 visits versus 38 visits, resp.), and number of patients requiring acute visits (15 patients versus 21 patients, resp.). When stratified by concomitant ICS use, patients on CIT were less likely to require an acute visit (46% versus 78%, resp.). Conclusions. Allergic asthmatics with cat sensitivity on CIT with close dander exposure have similar risk of asthma exacerbation compared to allergic asthmatics without cat sensitivity on immunotherapy. Aerik A. Williams, John R. Cohn, Shirley M. Fung, and Patricia Padams Copyright © 2013 Aerik A. Williams et al. All rights reserved. Probiotics as Additives on Therapy in Allergic Airway Diseases: A Systematic Review of Benefits and Risks Mon, 15 Jul 2013 10:24:50 +0000 Background. We conducted a systematic review to find out the role of probiotics in treatment of allergic airway diseases.  Methods. A comprehensive search of the major electronic databases was done till March 2013. Trials comparing the effect of probiotics versus placebo were included. A predefined set of outcome measures were assessed. Continuous data were expressed as standardized mean difference with 95% CI. Dichotomous data were expressed as odds ratio with 95% CI. P value < 0.05 was considered as significant. Results. A total of 12 studies were included. Probiotic intake was associated with a significantly improved quality of life score in patients with allergic rhinitis (SMD −1.9 (95% CI −3.62, −0.19); P = 0.03), though there was a high degree of heterogeneity. No improvement in quality of life score was noted in asthmatics. Probiotic intake also improved the following parameters: longer time free from episodes of asthma and rhinitis and decrease in the number of episodes of rhinitis per year. Adverse events were not significant. Conclusion. As the current evidence was generated from few trials with high degree of heterogeneity, routine use of probiotics as an additive on therapy in subjects with allergic airway diseases cannot be recommended. Rashmi Ranjan Das, Sushree Samiksha Naik, and Meenu Singh Copyright © 2013 Rashmi Ranjan Das et al. All rights reserved. Bilastine: A New Nonsedating Oral H1 Antihistamine for Treatment of Allergic Rhinoconjunctivitis and Urticaria Sun, 14 Jul 2013 10:07:32 +0000 Bilastine is a new, well-tolerated, nonsedating H1 receptor antihistamine. In the fasting state bilastine is quickly absorbed, but the absorption is slowed when it is taken with food or fruit juice. Therefore, it is recommended that bilastine is taken at least one hour before and no sooner than two hours after a meal. Clinical studies sponsored by the manufacturer have shown that bilastine 20 mg once daily is as efficacious as other nonsedating antihistamines in allergic rhinoconjunctivitis and chronic urticaria in individuals from 12 and 18 years of age, respectively. Bilastine is efficacious in all nasal symptoms including obstruction and in eye symptoms. The observations indicate that non-sedating antihistamines, as opposed to what has been thought previously, may be helpful in patients with allergic rhinitis in whom nasal obstruction is a major concern. Current international guidelines need to be revised in the light of the recent evidence. Research into aspects of pharmacokinetics and efficacy and adverse effect profiles of bilastine in children under 12 years of age is needed as are dose-response assessments and studies planned rigorously with the aim of assessing quality of life effects. Ole D. Wolthers Copyright © 2013 Ole D. Wolthers. All rights reserved. The Presence of Asthma, the Use of Inhaled Steroids, and Parental Education Level Affect School Performance in Children Tue, 09 Jul 2013 14:45:35 +0000 Objective. Childhood asthma is a frequent cause of absenteeism that affects school performance. We aimed to investigate the impact of asthma on absenteeism and school performance level of elementary and high school students. Methods. Data about sociodemographics, absenteeism, and academic achievement were obtained from 1539 students attending 98 schools in Greece. School performance was assessed for the last two years of school attendance using parents’ and teachers’ reports and grade point average promotion. Results. The mean of the days of absence of students with asthma was higher compared to the healthy students (6.2 ± 11.7 versus 0.3 ± 3.1, resp., ). Students with reduced healthcare use presented less absenteeism than those with increased healthcare use for asthma (4.3 ± 8.6 versus 12.4 ± 17.0 days, resp., ). Asthma and healthcare use for asthma accounted for an overall estimated variability in absence days of 13.8% and 9%, respectively. Absenteeism was associated with poor school performance for the last two years of school () and with lower grade point promotion in elementary school students () but not in high school students (). Higher level of parental education was associated with better school performance (). Asthma was associated with a decreased possibility for excellent performance (OR = 0.64, , 95%CI = 0.41–1.00) in elementary students. Students with asthma using inhalers were four times more likely to perform excellently in elementary school (OR = 4.3, , 95%CI = 1.17–15.95) than their asthmatic peers with alternative asthma treatments. Conclusions. Asthma and increased healthcare use enhance school absenteeism. Inhaled steroid use and the higher parental education level were the most important predicting factors for good school performance in elementary school asthmatic children. A. Tsakiris, M. Iordanidou, E. Paraskakis, A. Tsalkidis, A. Rigas, S. Zimeras, C. Katsardis, and A. Chatzimichael Copyright © 2013 A. Tsakiris et al. All rights reserved. Digestibility and IgE-Binding of Glycosylated Codfish Parvalbumin Wed, 26 Jun 2013 14:07:24 +0000 Food-processing conditions may alter the allergenicity of food proteins by different means. In this study, the effect of the glycosylation as a result of thermal treatment on the digestibility and IgE-binding of codfish parvalbumin is investigated. Native and glycosylated parvalbumins were digested with pepsin at various conditions relevant for the gastrointestinal tract. Intact proteins and peptides were analysed for apparent molecular weight and IgE-binding. Glycosylation did not substantially affect the digestion. Although the peptides resulting from digestion were relatively large (3 and 4 kDa), the IgE-binding was strongly diminished. However, the glycosylated parvalbumin had a strong propensity to form dimers and tetramers, and these multimers bound IgE intensely, suggesting stronger IgE-binding than monomeric parvalbumin. We conclude that glycosylation of codfish parvalbumin does not affect the digestibility of parvalbumin and that the peptides resulting from this digestion show low IgE-binding, regardless of glycosylation. Glycosylation of parvalbumin leads to the formation of higher order structures that are more potent IgE binders than native, monomeric parvalbumin. Therefore, food-processing conditions applied to fish allergen can potentially lead to increased allergenicity, even while the protein’s digestibility is not affected by such processing. Harmen H. J. de Jongh, Carlos López Robles, Eefjan Timmerman, Julie A. Nordlee, Poi-Wah Lee, Joseph L. Baumert, Robert G. Hamilton, Steve L. Taylor, and Stef J. Koppelman Copyright © 2013 Harmen H. J. de Jongh et al. All rights reserved.