<i>Background</i>. The prevalence of obesity has increased dramatically over the last decades, and its association with asthma is being increasingly recognized.<i> Aims</i>. Our hypothesis is that increased leptin and decreased adiponectin levels in obese subjects play a direct role in regulating inflammation in asthmatics. We wanted to examine the hypothesis that cysteinyl leukotrienes (cys-LT), inflammatory mediators that are regulated by adipokines, are involved in the pathogenesis of asthma.<i> Methods</i>. We studied a population of asthmatics and nonasthmatics, who in turn were divided into obese and nonobese categories. We examined leptin and its ratio to adiponectin, in asthmatics and nonasthmatics, with and without obesity. In addition, we measured cys-LT levels in exhaled breath condensate (EBC) and in peripheral blood monocytes (PBM) in these groups.<i> Results</i>. Leptin levels were increased in obese asthmatics compared to obese nonasthmatics. The leptin/adiponectin (L/A) ratio was higher in obese asthmatics compared to obese nonasthmatics. EBC cys-LT levels were elevated in asthmatics compared to nonasthmatics.<i> Discussion</i>. Proinflammatory adipokines, released from adipose tissue, may promote an asthma phenotype through enhanced cys-LT production that may result in more prevalent and difficult to control airway disease.

Michael J. Coffey

Barbara Torretti

Peter Mancuso

Adipokines and Cysteinyl Leukotrienes in the Pathogenesis of Asthma

<i  >Heliotropium indicum</i> is used traditionally as a remedy for conjunctivitis in Ghana. This study therefore evaluated the antiallergic potential of an aqueous whole plant extract of <i  >Heliotropium indicum</i> (HIE) in ovalbumin-induced allergic conjunctivitis and attempted to predict its mode of action. Clinical scores for allergic conjunctivitis induced by intraperitoneal ovalbumin sensitization (100&#x2009;:&#x2009;10&#x2009;<i  >&#x3bc;</i>g OVA/Al(OH)<sub  >3</sub> in phosphate-buffered saline [PBS]) and topical conjunctival challenge (1.5&#x2009;mg OVA in 10&#x2009;<i  >&#x3bc;</i>L PBS) in Dunkin-Hartley guinea pigs were estimated after a week&#x2019;s daily treatment with 30&#x2013;300&#x2009;mg&#x2009;kg<sup  >&#x2212;1</sup> HIE, 30&#x2009;mg&#x2009;kg<sup  >&#x2212;1</sup> prednisolone, 10&#x2009;mg&#x2009;kg<sup  >&#x2212;1</sup> chlorpheniramine, or 10&#x2009;mL&#x2009;kg<sup  >&#x2212;1</sup> PBS. Ovalbumin-specific IgG and IgE and total IgE in serum were estimated using Enzyme-Linked Immunosorbent Assay. Histopathological assessment of the exenterated conjunctivae was also performed. The 30 and 300&#x2009;mg&#x2009;kg<sup  >&#x2212;1</sup> HIE treatment resulted in a significantly (<svg  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"   style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 50.7895 11.7782" width="50.7895pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="593" vert-adv-y="593" /></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-93" d="M531 71V127L115 310L531 494V550L57 335V285L531 71ZM531 -40V10H57V-40H531Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="587" vert-adv-y="587" /></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="228" vert-adv-y="228" /></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g></svg>) low clinical score of allergic conjunctivitis. Ovalbumin-specific IgG and IgE as well as total serum IgE also decreased significantly (<svg  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg"   style="vertical-align:-3.42938pt" id="M2" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 44.5261 11.7782" width="44.5261pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="593" vert-adv-y="593" /></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-93" d="M531 71V127L115 310L531 494V550L57 335V285L531 71ZM531 -40V10H57V-40H531Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="587" vert-adv-y="587" /></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="228" vert-adv-y="228" /></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z" /><glyph.data ascent="3473" descent="-2876" horiz-adv-x="480" vert-adv-y="480" /></g></svg>&#x2013;0.001). The conjunctival tissue in HIE treated guinea pigs had mild mononuclear infiltration compared to the PBS-treated ones, which had intense conjunctival tissue inflammatory infiltration. HIE exhibited antiallergic effect possibly by immunomodulation or immunosuppression.

Samuel Kyei

George Asumeng Koffuor

Paul Ramkissoon

Samuel Abokyi

Osei Owusu-Afriyie

Eric Addo Wiredu

Possible Mechanism of Action of the Antiallergic Effect of an Aqueous Extract of <i>Heliotropium indicum</i> L. in Ovalbumin-Induced Allergic Conjunctivitis

Oral allergy syndrome (OAS) is an allergic reaction in the oral cavity subsequent to the consumption of food such as fruits, nuts, and vegetables.  It occurs mainly due to homology of proteins of pollen to the proteins of fruits and vegetables. In OAS, the immune system produces antibodies that are directed against the proteins of pollen and structurally similar proteins in food, hence, resulting in allergic symptoms limited mainly to the oral cavity. In this review, we have summarized the etiopathogenesis, clinical features, diagnosis, and management of OAS as an update for stomatologists.

Roopashri Rajesh Kashyap

Rajesh Shanker Kashyap

Oral Allergy Syndrome: An Update for Stomatologists

<i>Aim</i>. The aim of this study was to conduct a systematic review of population-based twin studies of (a) the concordance and heritability of AD and (b) the relationship between AD and asthma and, furthermore, to reinterpret findings from previous twin studies in the light of the emerging knowledge about filaggrin and its role in the atopic march and provide suggestions for future research in this area. <i>Methods</i>. We identified all twin studies (published after 1970) that have calculated the concordance rate and/or the heritability of AD, or the genetic and environmental correlations between AD and asthma. <i>Results</i>. Reported concordance rates for AD ranged, respectively. From 0.15 to 0.86 for MZ and from 0.05 to 0.41 for DZ twins, with an overall ratio of MZ&#x2009;:&#x2009;DZ twins of approximately three. The heritability of AD was estimated to be approximately 75&#x25;, and the association between AD and asthma was around 85&#x25; explained by genetic pleiotropy. <i>Conclusions</i>. Genetic factors account for most of the variability in AD susceptibility and for the association between AD and asthma. Controversy remains as to whether the atopic diseases are causally related or whether they are diverse clinical manifestations of a common, underlying (genetic) disease trait. Future twin studies may help solve this enigma.

Camilla Elmose

Simon Francis Thomsen

Twin Studies of Atopic Dermatitis: Interpretations and Applications in the Filaggrin Era

Journal of Allergy

Retracted: Immunopathology and Immunogenetics of Allergic Bronchopulmonary Aspergillosis

Asthma is one of the most common respiratory diseases affecting all age groups. The world is now trying to identify some dietary factors which can play a preventive role. We performed this systematic review and meta-analysis of RCTs to assess the effect of intake of polyunsaturated fatty acid (PUFA) in infancy and/or childhood on incidence of asthma or wheezing episodes. We searched MEDLINE, EBSCO, Trip, and Google Scholar up to January 31, 2015. All RCTs where infants or children who were given omega-3 fatty acid supplementation and which reported incidence of asthma and/or wheezing episodes as dichotomous outcomes were included in this review. Random effects model was used for pooling the risk estimates. Total five articles were included. Most of them were from Australia. On meta-analysis, the pooled estimate of odds ratios by random effects model showed no significant change in incidence of asthma after supplementation of omega-3 FA in infancy or childhood (OR 0.974; CI 0.646, 1.469; <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 50.7895 11.7782" width="50.7895pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.013,0,0,-0.013,38.05,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.29,0)"><use xlink:href="#g113-49"/></g></svg>).  We concluded that a multicentric RCT is required to assess the effect of omega-3 FA supplementation exclusively to infants or children to predict the best time of omega-3 FA supplementation to prevent asthmatic or wheezing episodes later in life.

Prasad Muley

Monali Shah

Arti Muley

Omega-3 Fatty Acids Supplementation in Children to Prevent Asthma: Is It Worthy?&#x2014;A Systematic Review and Meta-Analysis

<i>Introduction</i>. Children with severe food allergies may spend many hours in the preschool setting. Little is known about anaphylaxis recognition and management preparedness among preschool staff. The objective of this study was to assess anaphylaxis preparedness among preschool staff. <i>Methods</i>. Anonymous questionnaires were administered before and after a 40-minute educational seminar on anaphylaxis recognition and management. <i>Results</i>. In total, 181 individuals participated in the preintervention survey and 171 participated in the postintervention survey. The comfort level with recognizing anaphylaxis and administering an epinephrine autoinjector significantly increased after the intervention (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6370001pt" id="M1" height="9.2729pt" version="1.1" viewBox="-0.0498162 -8.6359 44.8393 9.2729" width="44.8393pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-81" d="M600 480C600 590 528 650 384 650H143L137 622C222 614 225 607 210 531L130 127C113 41 106 36 23 28L17 0H294L300 28C204 36 195 42 212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g><g transform="matrix(.013,0,0,-0.013,22.921,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,25.885,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g></svg> for both). Of the 5 steps needed to administer an epinephrine autoinjector, staff named a mean (SD) of 3 (1.3) steps in the correct order compared with 4.2 (1.1) steps after the educational intervention (<svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" style="vertical-align:-0.6370001pt" id="M2" height="9.2729pt" version="1.1" viewBox="-0.0498162 -8.6359 44.8393 9.2729" width="44.8393pt"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-81"/></g><g transform="matrix(.013,0,0,-0.013,11.658,0)"><use xlink:href="#g117-91"/></g><g transform="matrix(.013,0,0,-0.013,22.921,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,25.885,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,32.125,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.365,0)"><use xlink:href="#g113-50"/></g></svg>). <i>Conclusion</i>. This study shows that a brief education intervention can significantly increase caregiver comfort regarding identifying anaphylaxis and administering an epinephrine autoinjector.

Ashley A. Foster

Ronna L. Campbell

Sangil Lee

Jana L. Anderson

Anaphylaxis Preparedness among Preschool Staff before and after an Educational Intervention

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