Asthma is commonly described as an atopic disease in childhood, but some cases of this disorder do not fit this description. The aim of this study was to evaluate the frequency of atopy, asthma, and sensitization to house dust mites in children with allergic symptoms. This study was performed at the Severance Hospital of Yonsei University with patients who visited the allergy clinic for evaluation of nonspecific upper respiratory symptoms, typical symptoms of asthma, or a general health workup. The patients were divided into three age groups: 0-3 years (group 1), 4-7 years (group 2), and 8-12 years (group 3). Of the 1,244 children examined, 844 (67.8%) were atopic and 400 (32.2%) were non-atopic. The frequency of atopy and asthma increased with age. Asthma was diagnosed in the same proportion (64%) of atopic and non-atopic children. As risk factors for asthma symptoms, the positive values of house dust mite (HDM) sensitivity were significantly increased in groups 1, 2, and 3 to 53.5%, 68.9%, and 80.2%, respectively. A significant difference between the percentage of asthmatics sensitized to HDM and that of asthmatics not sensitized to HDM was found only in group 3. In conclusion, asthma is related to atopy with increasing age, and house dust mite sensitization seems to be an important determinant of asthma in older children in Korea.
Asthma; atopy; house dust mite
In vitro and in vivo clinical and experimental data have suggested that leukotrienes play a key role in inflammatory reactions of the skin. Antileukotriene drugs, ie, leukotriene receptor antagonists and synthesis inhibitors, are a class of anti-inflammatory drugs that have shown clinical efficacy in the management of asthma and in rhinitis with asthma. We searched MEDLINE database and carried out a manual search on journals specializing in allergy and dermatology for the use of antileukotriene drugs in urticaria. Montelukast might be effective in chronic urticaria associated with aspirin (ASA) or food additive hypersensitivity or with autoreactivity to intradermal serum injection (ASST) when taken with an antihistamine but not in mild or moderate chronic idiopathic urticaria [urticaria without any possible secondary causes (ie, food additive or ASA and other NSAID hypersensitivity, or ASST)]. Evidence for the effectiveness of zafirlukast and the 5-lipoxygenase inhibitor, zileuton, in chronic urticaria is mainly anecdotal. In addition, there is anecdotal evidence of effectiveness of antileukotrienes in primary cold urticaria, delayed pressure urticaria and dermographism. No evidence exists for other physical urticarias, including cholinergic, solar and aquagenic urticarias, vibratory angioedema, and exercise-induced anaphylaxis.
chronic idiopathic urticaria; leukotriene receptor antagonists; montelukast; zafirlukast; antihistamine
Nasal polyposis (NP) is a chronic inflammatory disease of unknown etiology that impairs quality of life (QoL). The role of atopy in NP is not established. The aim of this study was to describe the clinical characteristics and QoL in a broad sample of patients with NP and to evaluate the influence of allergy on this disease.
A multicenter, observational, cross-sectional study was conducted in 67 allergy units in Spain. NP and nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity were diagnosed following EP3OS guidelines. Rhinitis and asthma were classified following Allergic Rhinitis and Its Impact on Asthma and the Global Initiative for Asthma guidelines, respectively. Skin tests with a battery of aeroallergens were performed on all patients. A visual analog scale (VAS) and Short-Form 12 (SF-12) and 31-item Rhinosinusitis Outcome Measure (RSOM 31) questionnaires were completed by all the patients.
Of the 671 patients included, 611 were evaluable. Mean age was 46 years and 50% of patients were men. Also, 50% were atopic. Asthma was present in 66% of patients and NSAID hypersensitivity was present in 26%. The most frequent symptoms were nasal congestion and rhinorrhea. Mean value of VAS was 58.6. Global health and bodily pain were the items most frequently identified in the SF-12 questionnaire and nasal and ocular symptoms in the RSOM-31 questionnaire. There was a good correlation between VAS score and QoL (p < 0.0001). Rhinitis was more severe in nonallergic patients. Asthma was more frequent in atopic patients, whereas ASA triad was more frequent in nonatopic patients. Atopic patients showed higher VAS scores and worse QoL.
Atopic NP patients showed worse QoL, higher incidence of asthma and a less severe form of rhinitis than non-atopic patients.
Aeroallergens; allergy; asthma; atopy; cross-sectional study; nasal polyposis; NSAID hypersensitivity; quality of life; rhinitis; skin tests
According to hygiene hypothesis, a lower exposure to infection is associated with increased prevalence of allergic diseases. This study aimed to investigate the association between atopy and Toxoplasma gondii (Tg) infection by analyzing the antibody and cytokine responses to house dust mite allergens and T. gondii antigens in Brazilian subjects. A total of 275 individuals were assessed and divided into atopics (n=129) and non-atopics (n=146) based on markers of allergy (positive skin prick test and ELISA-IgE to mite allergens) or Tg-seropositive (n=116) and Tg-seronegative (n=159) groups according to infection markers (positive ELISA-IgG to T. gondii). Tg-seropositive individuals presented lower allergenic sensitization (37%) to mite allergens than Tg-seronegative subjects (54%). A significant association was found between atopy and negative serology to T. gondii (OR: 2.0; 95% CI: 1.23–3.26; P<0.05). Proliferative responses and cytokine production after antigenic stimulation showed predominant synthesis of Th1-cytokines as IFN-γ in Tg-seropositive patients, whether atopics or non-atopics. Conversely, Th2-cytokines as IL-5 prevailed in atopics compared to non-atopics, regardless the seropositivity to T. gondii. Levels of IL-10, IL-13, IL-17, and TGF-β were not able to discriminate the groups. Hence, a negative association between atopy and infection by T. gondii was demonstrated for the first time in Brazilian subjects, focusing on the antibody and cytokine responses and indicating that the immunomodulation induced by the parasite may play a protective role in the development of allergic diseases.
Toxoplasma gondii; Allergic diseases; House dust mites; Hygiene hypothesis; IgE antibodies; Cytokines
Oral mite anaphylaxis is a new syndrome characterized by severe allergic manifestations occurring in atopic patients shortly after the intake of foods made with mite-contaminated wheat flour. This clinical entity, observed more frequently in tropical/subtropical environments, is more often triggered by pancakes and for that reason it has been designated "pancake syndrome". Because cooked foods are able to induce the symptoms, it has been proposed that thermoresistant allergens are involved in its production. A novel variety of this syndrome occurs during physical exercise and therefore has been named dust mite ingestion-associated exercise-induced anaphylaxis. To prevent mite proliferation and the production of anaphylaxis, it has been recommended that wheat flour be stored at low temperatures in the refrigerator.
anaphylaxis; exercise-induced anaphylaxis; food allergy; immunoglobulin E; mites
Asia is a populous and diverse region and potentially an important source of information on food allergy. This review aims to summarize the current literature on food allergy from this region, comparing it with western populations. A PubMed search using strategies "Food allergy AND Asia", "Food anaphylaxis AND Asia", and "Food allergy AND each Asian country" was made. Overall, 53 articles, published between 2005 and 2012, mainly written in English were reviewed. The overall prevalence of food allergy in Asia is somewhat comparable to the West. However, the types of food allergy differ in order of relevance. Shellfish is the most common food allergen from Asia, in part due to the abundance of seafood in this region. It is unique as symptoms vary widely from oral symptoms to anaphylaxis for the same individual. Data suggest that house dust mite tropomysin may be a primary sensitizer. In contrast, peanut prevalence in Asia is extremely low compared to the West for reasons not yet understood. Among young children and infants, egg and cow's milk allergy are the two most common food allergies, with prevalence data comparable to western populations. Differences also exist within Asia. Wheat allergy, though uncommon in most Asian countries, is the most common cause of anaphylaxis in Japan and Korea, and is increasing in Thailand. Current food allergy data from Asia highlights important differences between East and West, and within the Asian region. Further work is needed to provide insight on the environmental risk factors accounting for these differences.
Food Allergy; Asia; West; Epidemiology; Prevalence; Shellfish
The pathogenesis of aspirin-exacerbated respiratory disease (AERD) is presumed to involve the aspirin/non steroidal anti-inflammatory drug (NSAID)-induced abnormal metabolism of arachidonic acid, resulting in the production of 5-lipoxygenase metabolites, particularly leukotriene C4. Aspirin intolerance occurs around the same time as asthma onset, and a few of the patients with AERD had suffered from pediatric asthma. Although atopy is not associated with the pathogenesis of AERD, some of the patients with AERD have aeroallergen sensitization. There are few studies in which the association between the pathogenesis of AERD and atopy has been clarified.
Ninety AERD patients, whose aspirin sensitivity was determined by the aspirin challenge test, and 100 aspirin-tolerant asthma (ATA) patients, whose age and sex were adjusted, participated in this study. Atopy was defined as a positive reaction in an intradermal test to one or more of 19 common aeroallergens, or a positive reaction above class one in Immuno CAP RAST. We analyzed the relationships between aeroallergen sensitization and clinical settings of AERD patients.
The atopic and non atopic AERD groups showed median serum total IgE concentrations of 464 and 130 IU/l (P value = 0.004), respectively. The asthma of atopic patients with AERD was milder than that of non atopic patients with AERD. (P value = 0.05) The Lund-Mackay score of atopic patients with AERD was lower than that of non atopic patients with AERD. (P value = 0.02)
Two-thirds of the patients with AERD showed aeroallergen sensitization. The asthma and sinusitis in atopic patients with AERD were significantly milder than those in non atopic patients with AERD. Aeroallergen sensitization might prevent the worsening of asthma in patients with AERD.
Although the pathophysiology of immunoglobulin E (IgE)-mediated allergic rhinoconjunctivitis and bronchial asthma is rather well established, the role of allergy in atopic eczema (AE) is still controversial. By a technique called atopy patch test, aeroallergens like house dust mite, animal dander, or pollen were proven as relevant trigger factors in a subgroup of patients with AE. The atopy patch test is an epicutaneous patch test with such allergens known to elicit IgE-mediated reactions, and used for the evaluation of eczematous skin reactions. In a series of single-center and multicenter studies, a method was developed, standardized, and compared with other diagnostic techniques (radioallergosorbent test, skin prick test) in AE patients. With regard to clinical history, the most specific results were obtained with the atopy patch test (allergen-dependent, 69%-92%), whereas sensitivity was higher for skin prick test (range, 69%-82%) and specific IgE (range, 65%-94%). The characterization of a patient subgroup with relevant IgE-mediated allergy may lead to more efficient avoidance and eventually even specific immunotherapy strategies in the management of AE.
IgE; diagnostic techniques; atopy patch test; atopic eczema
Anaphylaxis after the ingestion of foods contaminated with mites has recently been reported. It is an immediate and potentially life-threatening reaction in patients with previous allergic rhinitis and/or asthma following the ingestion of mite-contaminated foods. Case series and case reports thus far have shown that mite-contaminated wheat flour is the major cause of oral mite anaphylaxis. However, we have encountered 8 cases of oral mite anaphylaxis in our hospital not caused by mite-contaminated wheat flour but by mite-contaminated okonomiyaki mix.
To review the current literature, in addition to our patients, we performed a MEDLINE search of articles on oral mite anaphylaxis in Japan up to June 2011 and collected patient characteristics, interview contents, results on specific IgE against mites, wheat, and pollen and other antigens, results of skin prick tests including those using extracts from mites and/or culprit flours, and microscopic examination results.
We found thirty oral mite anaphylaxis patients in Japan twenty-eight (93.3%) of whom ingested okonomiyaki or takoyaki, prepared at home using okonomiyaki mix (24 patients) or takoyaki mix (4 patients), respectively, which was previously opened and stored for months at ambient temperature. Takoyaki mix is similar to okonomiyaki mix, which is composed of flour, dried scallop, bonito, and mackerel. The other 2 patients ingested pancake mix. Microscopic examination of thirteen patients’ mixes revealed contaminating mites. Thyreophagus putrescentiae, Dermatophagoides pteronyssinus, Dermatophagoides farinae were found in mix samples of 4, 3, and 3 patients, respectively. The specific IgE against each mite is generally upregulated, which might be affected by cross-reactivities to other mites. Especially, the specific IgEs to Dermatophagoides pteronyssinus and Dermatophagoides farina were more than class 2 in all cases. It is suggested that mites are attracted to the flavors of okonomiyaki and takoyaki mixes and invade from a crack in a flour sack, and proliferate under favorable conditions.
Mite-contaminated flavored mix is a major cause of oral mite anaphylaxis in Japan.
Non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in hypersensitivity drug reactions. Histamine is released in the allergic response to NSAIDs and is responsible for some of the clinical symptoms. The aim of this study is to analyze clinical association of functional polymorphisms in the genes coding for enzymes involved in histamine homeostasis with hypersensitivity response to NSAIDs. We studied a cohort of 442 unrelated Caucasian patients with hypersensitivity to NSAIDs. Patients who experienced three or more episodes with two or more different NSAIDs were included. If this requirement was not met diagnosis was established by challenge. A total of 414 healthy unrelated controls ethnically matched with patients and from the same geographic area were recruited. Analyses of the SNPs rs17740607, rs2073440, rs1801105, rs2052129, rs10156191, rs1049742 and rs1049793 in the HDC, HNMT and DAO genes were carried out by means of TaqMan assays. The detrimental DAO 16 Met allele (rs10156191), which causes decreased metabolic capacity, is overrepresented among patients with crossed-hypersensitivity to NSAIDs with an OR = 1.7 (95% CI = 1.3–2.1; Pc = 0.0003) with a gene-dose effect (P = 0.0001). The association was replicated in two populations from different geographic areas (Pc = 0.008 and Pc = 0.004, respectively).
Conclusions and implications
The DAO polymorphism rs10156191 which causes impaired metabolism of circulating histamine is associated with the clinical response in crossed-hypersensitivity to NSAIDs and could be used as a biomarker of response.
To summarize the existing literature on the association of endotoxin with respiratory diseases and allergic sensitization and to review the potentially modifying effects of endotoxin receptor polymorphisms.
English-language articles were identified from the MEDLINE and PubMed databases using combinations of the following search terms: endotoxin, toll-like receptor, polymorphisms, atopy, asthma, and allergy. Other sources included experts in the field and the bibliographies of pertinent articles.
Relevant articles were selected based on the authors’ expert opinion.
Cross-sectional studies, particularly those of children raised in rural European communities, suggest that early endotoxin exposure may protect against the development of allergic sensitization and atopic asthma. However, endotoxin exposure may also contribute to other nonatopic respiratory disorders and may exacerbate disease in individuals with preexisting asthma. Paradoxically, among individuals exposed to high levels of endotoxin, carriers of a functional mutation in toll-like receptor 4, which reduces cellular responsiveness to endotoxin, may be at lower risk of developing allergic sensitization.
The effect of endotoxin exposure on allergic sensitization and asthma appears to be influenced by the timing of exposure, the presence or absence of preexisting disease, and polymorphisms in the genes that encode endotoxin receptors. Further studies are needed to define the window period for this effect, as well as the underlying immunologic mechanism.
The atopic diseases are generally diagnosed by performing skin prick tests (SPTs) to different aeroallergens. However, when this study results negative, it is possible to perform atopy patch test (APT). This technique has been introduced to evaluate sensitization to aeroallergens in patients with atopic eczema dermatitis syndrome. Nevertheless, its role in other allergic diseases has not been proved. Objective: Evaluate aeroallergens response using skin prick test (SPT) and atopy patch test (APT) in patients with allergic diseases.
Retrospective cohort study of individuals who performed SPT and APT as part of allergic diseases study. The study subjects were patch and skin prick tested to house dust mite (Dermatophagoides), trees, grass and fungi mix, cat and dog dander, among others. The tests were performed at the respiratory allergic disease center of Santa Maria Clinic in Santiago, Chile, between January 2010 and April 2011.
Fifty-five patients were included, 18 (33%) males and 37 (67%) females, median age 6 years (range from 3 months to 62 years), with the following diagnosis: atopic dermatitis syndrome (60%), allergic rhinitis (58%), contact allergic dermatitis (16%), asthma (9%), recurrent bronchial obstructive syndrome (7%), allergic rhinoconjuctivitis (4%), chronic cough (4%), recurrent acute otitis media (2%) and recurrent laryngitis (2%). They underwent usual SPTs and APTs with multiple aeroallergens extracts. Of the 55 patients, 22 showed a positive SPT and 32 a positive APT; in 14 (25%) both, SPT and APT were positive. In 8 (15%) the SPT was positive and APT negative, while in 18 (33%) the SPT was negative, but the APT positive. Fifteen (27%) were negative to both tests.
Our results show that APT might be a useful diagnosis test in patients with allergic diseases and that its routine use can improve their diagnosis.
This is a review on published data available on food allergy in East Asia and a discussion on the insights that it offers.
PubMed searches were made for terms food allergy and anaphylaxis, in combination with Asia.
There is a paucity of population-based prevalence studies on food allergy in Asia. Certain unique food allergens, such as buckwheat, chestnuts, chickpeas, bird's nest, and royal jelly, which are consumed extensively by certain Asian populations have resulted in clinical food allergy of little importance in other populations. Crustacean shellfish is of importance in this region relative to other common food allergens. The high consumption of these foods and possibly coupled with cross-reactive tropomyosins from dominant inhalant dust mite and cockroach allergens in this region may explain this phenomenon. In contrast, the prevalence of peanut allergy is relatively low in this region. The reasons for this difference are not apparent. However, this may be a reflection of the general reduced propensity in this region to allergic diseases as seen with asthma.
Further research on food allergy in Asia is warranted because it offers unique opportunities to further our understanding on the influence of population and environment.
food allergy; Asia; shellfish allergy; peanut allergy; buckwheat; bird's nest; chickpeas; royal jelly
The objectives of this study are 1) To review the published data and document the current knowledge on allergic manifestations to the fruit mango 2) To highlight the two distinct clinical presentations of hypersensitivity reactions caused by mango 3) To discuss the role of cross-reactivity 4) To increase awareness of potentially life threatening complications that can be caused by allergy to mango. An extensive search of the literature was performed in Medline/PubMed with the key terms "mango", "anaphylaxis", "contact dermatitis", "cross-reactivity", "food hypersensitivity", "oral allergy syndrome" and "urticaria". The bibliographies of all papers thus located were searched for further relevant articles. A total of 17 reports describing 22 patients were documented, including ten patients with immediate hypersensitivity reaction and twelve patients with delayed hypersensitivity reaction to mango. Ten of these patients (four with immediate reaction; six with delayed reaction) were from geographical areas cultivating mango, whereas twelve patients (six with immediate reaction; six with delayed reaction) were from the countries where large scale mango cultivation does not occur. The clinical features, pathogenesis and diagnostic modalities of both these presentations are highlighted. The fruit mango can cause immediate and delayed hypersensitivity reactions, as also "oral allergy syndrome". Although rare, it can even result in a life threatening event. Reactions may even occur in individuals without prior exposure to mango, owing to cross reactivity. It is imperative to recognize such a phenomenon early so as to avoid potentially severe clinical reactions in susceptible patients.
Allergy; Anaphylaxis; Contact dermatitis; Cross-reactivity; Mango; Oral allergy syndrome; Urticaria
In the large majority of previous studies, patients with a history of acute urticaria induced by nonsteroidal anti-inflammatory drugs (NSAIDs) seeking safe alternative drugs have undergone tolerance tests uniquely with compounds exerting little or no inhibitory effect on the cyclooxygenase 1 enzyme. In light of recently published studies, however, this approach seems inadequate and should be changed. The present article critically reviews the clinical management of patients presenting with a history of urticaria induced by a single NSAID or multiple NSAIDs and suggests a simple, updated diagnostic algorithm that may assist clinicians in correctly classifying their patients.
aspirin; drug allergy; nonsteroidal anti-inflammatory drug; urticaria
The cutaneous lymphocyte-associated antigen (CLA) is the major T cell ligand for the vascular adhesion molecule E-selectin, and it has been proposed to be involved in the selective targeting of memory T cells reactive with skin-associated Ag to cutaneous inflammatory sites. To further investigate the relation of CLA and cutaneous T cell responses, we analyzed the CLA phenotype of circulating memory T cells in patients with allergic contact dermatitis and atopic dermatitis (AD) alone vs in patients manifesting bronchopulmonary atopy (asthma with or without AD) and nonallergic individuals. Significant T cell proliferative responses to Ni, a contact allergen, and to the house dust mite (HDM), an allergen to which sensitization is often observed in AD and/or asthma, was noted only in allergic and atopic individuals, respectively. When the minor circulating CLA+CD3+CD45RO+ subset was separated from the major CLA-CD3+CD45RO+ subpopulation in Ni-sensitive subjects, the Ni- dependent memory T cell response was largely confined to the CLA+ subset. A similar restriction of the T cell proliferative response to the CLA+ memory subset was observed for HDM in patients with AD alone. In HDM-sensitive patients with asthma with or without AD, however, the CLA- subset exhibited a strong antigen-dependent proliferation, in contrast to patients with AD alone, whose CLA- subset proliferated very weakly to HDM. In asthma with or without AD, the HDM-dependent proliferation slightly predominated in the CLA- when compared to the CLA+ subset. The functional linkage between CLA expression and disease- associated T cell effector function in AD was also demonstrated by the finding that the circulating CLA+ T cell subset in AD patients, but not nonatopic controls, selectively showed both evidence of prior activation (human histocompatibility antigen-DR expression) and spontaneous production of interleukin 4 but not interferon-gamma. Taken together, these observations demonstrate the correlation of CLA expression on circulating memory T cells and disease-associated memory T cell responses in cutaneous hypersensitivity, and they suggest the existence of mechanisms capable of sorting particular T cell Ag specificities and lymphokine patterns into homing receptor-defined memory subsets.
Background. An in vitro basophil activation test, based on the detection of CD63 upregulation induced by NSAIDs, has been described. Its clinical significance remains controversial. Objectives. In patients with a history of nonallergic NSAID hypersensitivity, stratified according to the severity of the symptoms, to assess with NSAIDs the predictive value of basophil (BAT) and monocyte (MAT) activation tests. Patients/Methods. Sixty patients who had NSAIDs-induced or exacerbated urticaria/angiooedema and 20 controls was included. After incubation with NSAIDs or acetaminophen, leukocytes were analysed for CD63 upregulation. Results. With aspirin, the sensitivity (37%) and specificity (90%) of BAT agree with already published results. In contrast, when patients had had cutaneous and visceral reactions, the frequency of positive BAT 14/22 (64%, P < 0.001) or MAT 10/22 (46%, P < 0.01) were increased. Conclusions. Positive tests were more frequent among patients having a severe hypersensitivity contrasting with the other patients who had results similar to controls.
Maternal atopic background and stimulation of the adaptive immune system with allergen interact in the development of allergic disease. Stimulation of the innate immune system through microbial exposure, such as activation of the innate Toll-like-receptor 2 (TLR2), may reduce the development of allergy in childhood. However, little is known about the immunological effects of microbial stimulation on early immune responses and in association with maternal atopy.
We analyzed immune responses of cord blood mononuclear cells (CBMC) from 50 healthy neonates (31 non-atopic and 19 atopic mothers). Cells were stimulated with the TLR2 agonist peptidoglycan (Ppg) or the allergen house dust mite Dermatophagoides farinae (Derf1), and results compared to unstimulated cells. We analyzed lymphocyte proliferation and cytokine secretion of CBMC. In addition, we assessed gene expression associated with T regulatory cells including the transcription factor Foxp3, the glucocorticoid-induced TNF receptor (GITR), and the cytotoxic lymphocyte antigen 4 (CTLA4). Lymphocyte proliferation was measured by 3H-Thymidine uptake, cytokine concentrations determined by ELISA, mRNA expression of T cell markers by real-time RT-PCR.
Ppg stimulation induced primarily IL-10 cytokine production, in addition to IFN-γ, IL-13 and TNF-α secretion. GITR was increased following Ppg stimulation (p = 0.07). Ppg-induced IL-10 production and induction of Foxp3 were higher in CBMC without, than with maternal atopy (p = 0.04, p = 0.049). IL-10 production was highly correlated with increased expression of Foxp3 (r = 0.53, p = 0.001), GITR (r = 0.47, p = 0.004) and CTLA4 (r = 0.49, p = 0.003), independent of maternal atopy.
TLR2 stimulation with Ppg induces IL-10 and genes associated with T regulatory cells, influenced by maternal atopy. Increased IL-10 and Foxp3 induction in CBMC of non-atopic compared to atopic mothers, may indicate an increased capacity to respond to microbial stimuli.
Background. In the present study, quality and quantity of indoor dust mites was evaluated at the residence of 150 atopic allergic patients from four different districts of South Assam. Methods. Suspected patients with case history of allergic disease were selected for indoor survey. Dust samples (500 mg) were collected from the selected patient's house and were analyzed using standard methods. Results. About 60% of the selected patients were found suffering from respiratory disorders and rest 40% from skin allergy. The dominant mites recorded from indoor dust samples were Dermatophagoides followed by Blomia, Acarus, and Cheyletus while Caloglyphus was recorded in least number. The distribution of mites on the basis of housing pattern indicates that RCC type of buildings supports maximum dust mite's population followed by Assam type (semi-RCC) buildings, and the lowest count was observed in wooden houses. Environmental factors like temperature, rainfall, and relative humidity are found to determine the indoor mite's population. Severity of allergic attack in some of the typical cases was found to be proportional to the allergen load of mites in the dust samples. Conclusions. The economic status, housing pattern, and local environmental factors determine the diversity and abundance of dust mites in indoor environment.
A study was performed to assess the time between drug intake and drug induced
hypersensitivity reaction for patients sensitive to nonsteroidal
antiinflammatory drugs (NSAID) in clinical patient history and after oral
provocation tests. Drug hypersensitivity ENDA questionnaires were filled for the
patients with suspected sensitivity to NSAID. Oral provocation tests were
performed with suspected NSAID according to the ENDA/EAACI recommendations.
There were 76 patients with history of hypersensitivity reactions after use of
NSAID enrolled in the study. Recorded were 154 hypersensitivity reactions to
NSAID in the clinical history. In the clinical history median time of immediate
reactions (76 cases, 81%) between drug intake and bronchospasm was 20 minutes
[15-30 minutes]. Median time of nonimmediate reactions (18 cases, 19%) was 120
minutes [120-390 minutes]. There were 50 oral provocation tests performed, 14 of
them (28%) were positive. Median time between drug intake and immediate
reactions (8; 57% of cases) was 22.5 minutes [20-30 minutes] and median time of
nonimmediate reactions (6; 43% of cases) was 167.5 minutes [125-206.25 minutes].
Time delay between drug intake and bronchospasm in the clinical history and
after oral provocation test was not statistically different.
hypersensitivity to nonsteroidal antiinflammatory drugs; bronchospasm; asthma; aspirin
Hypersensitivities induced by isopropylantipyrine (IPA), a pyrazolone derivative within the wider family of non-steroidal anti-inflammatory drugs (NSAIDs), are rarely reported. We characterized the clinical features of 12 patients with IPA-induced hypersensitivity. Twelve patients with immediate hypersensitivity to IPA were enrolled and classified into two groups: group I, consisting of eight patients (66.7%) with selective hypersensitivity; and group II, consisting of four patients (33.3%) showing cross-intolerance to other NSAIDs. Skin prick and intradermal and oral provocation tests with IPA were performed. To confirm selective hypersensitivity, an aspirin oral provocation test was also conducted. The most common manifestations were cutaneous reactions (91.7%), followed by anaphylaxis (66.7%), respiratory (41.7%), ocular (16.7%), and gastrointestinal reactions (16.7%). The median age and the median age at onset were 34.5 (range, 23-55) years and 28.0 (range, 7-47) years, respectively. In both groups I and II, all patients showed negative responses to skin prick testing, whereas only two patients in group I were positive in response to intradermal IPA tests. The response time after drug exposure was shorter in group I than in group II. Here, we report on two types of IPA hypersensitivity: selective and cross-intolerant NSAID hypersensitivity. An immediate IgE-mediated reaction may be involved in patients with selective hypersensitivity, whereas a cyclooxygenase-1-related inhibition mechanism may be a responsible mechanism for the patients with cross-intolerance to multiple NSAIDs.
Drug hypersensitivity; immediate hypersensitivity; isopropylantipyrine; pyrazolone
The house-dust mite (HDM), commonly found in human dwellings, is an important source of inhalant and contact allergens. In this report, the importance of HDM allergy in Korea and the characteristics of allergens from dust mite are reviewed with an emphasis on investigations performed in Korea. In Korea, Dermatophagoides farinae is the dominant species of HDM, followed by D. pteronyssinus. Tyrophagus putrescentiae is also found in Korea, but its role in respiratory allergic disease in Korea is controversial. The relatively low densities of mite populations and concentrations of mite major allergens in dust samples from Korean homes, compared to westernized countries, are thought to reflect not only different climatic conditions, but also cultural differences, such as the use of 'ondol' under-floor heating systems in Korean houses. HDM are found in more than 90% of Korean houses, and the level of exposure to HDM is clinically significant. About 40%-60% of Korean patients suffering from respiratory allergies, and more than 40% of patients suffering from atopic dermatitis, are sensitized to HDM. Mite allergens can be summarized according to their inherent auto-adjuvant activities and/or their binding affinities to the adjuvant-like substances: proteolytic enzymes, lipid binding proteins, chitin binding proteins, and allergens not associated with adjuvant-like activity. In general, allergens with a strong adjuvant-like activity or adjuvant-binding activity elicit potent IgE reactivity. In Korea, Der f 2 is the most potent allergen, followed by Der f 1. Immune responses are modulated by the properties of the allergen itself and by the adjuvant-like substances that are concomitantly administered with the antigens. Characterization of allergenic molecules and elucidation of mechanisms by which adjuvant-like molecules modulate allergic reactions, not only in Korea but also worldwide, will provide valuable information on allergic diseases, and are necessary for the development of diagnostic tools and therapeutic strategies.
Allergen; allergy; house dust mite; Korea
Two cases of women in their thirties with past histories of atopic dermatitis and allergic rhinitis developed a low grade fever, followed by a butterfly-shaped erythema, swelling of their fingers, and polyarthralgia. Despite such symptoms that overlap with those of systemic lupus erythematosus (SLE), the diagnostic criteria for SLE were not fulfilled. Due to positive results for human parvovirus B19 (HPV-B19) IgM antibodies in the serum, diagnoses of HPV-B19 infection were made in both cases. Although acetaminophen failed to improve their deteriorating symptoms, a nonsteroidal anti-inflammatory drug (NSAID), loxoprofen, completely removed the symptoms immediately after the administration. In those cases, since the patients were predisposed to atopic disorders, an increased immunological response based on the lymphocyte hypersensitivity was likely to be involved in the pathogenesis. The immunomodulatory property of NSAID was thought to repress such lymphocyte activity and thus provided a rapid and sustained remission of the disease.
The increasing trend in allergic diseases has become obvious in the present day, especially in developing countries like India, because of many factors such as change in ambient air quality, increased air pollution, metamorphic change in living habits and lifestyle, and climate.1 Mites present in house dust represent a major source of allergens, resulting in different allergic manifestations all over the world, and hypersensitivity to these dust mites may play a pivotal role in pathogenesis of several allergic complaints including bronchial asthma. The present study evaluated the sensitization toward house dust and house dust mites among patients residing in Kolkata metropolis, India, who are suffering from allergic asthma.
The skin prick test was performed on a total of 1079 patients (585 males and 494 females) between the age group 5–50 years and 50 healthy controls using a variety of 16 common aero-allergenic extracts including 4 allergens of interest, viz. Dermatophagoides pteronyssinus, Dermatophagoides farinae, and Blomia tropicalis and total house dust allergens. Total serum IgE level was measured by using the EIA technique and specific IgE levels against aforesaid allergens were detected with the Pharmacia ImmunoCAP 100 System. The influence of age and sex, if any, on allergen sensitivity was also investigated. All statistical analyses were performed using SPSS 10.0 for Windows and Zar.2
The responses among patients with asthma to house dust and house dust mite allergen tests were as follows: house dust (96.22%), D. pteronyssinus (75.06%), B. tropicalis (72%), and D. farinae (63.72%). The frequency of positive skin response was found to be independent of age and sex. The total serum IgE levels in patients varied between 7.3 and 4040 IU/ml (mean 369 ± 26.51 IU/ml). Specific IgE antibody test proved that 83% patients showed sensitivity toward at least 1 of the allergens tested.
The results indicate that patients are highly sensitive to house dust and 3 other allergenic mites, namely, D. pteronyssinus, D. farinae, and B. tropicalis, as evidenced by the skin prick test, quantification of total serum IgE, and detection of allergen-specific IgE antibodies among patients of Kolkata. Although mites belonging to the genus Dermatophagoides have already been incriminated as a major source of allergen in house dust in India, this is the first time the role of B. tropicalis mites causing allergic asthma has been reported from an Indian population. Thus, the importance of B. tropicalis mite as an aetiopathological agent in causing various allergic manifestations among the Kolkata population should not be undermined and the allergen should be included in routine allergy testing.
allergy; Dermatophagoides spp.; Blomia tropicalis; house dust; skin prick test; IgE
Several in vivo and in vitro studies have shown that metal-rich particles may enhance allergic responses to house dust mites and induce an increased release of allergy-related cytokines.
The main goal of this analysis is to define the possible association of intrauterine exposure to lead and mercury with the occurrence of skin sensitization to common aeroallergens in early childhood.
Material and Methods
The present study refers to a sample of 224 women in the second trimester of pregnancy recruited from Krakow inner city area who had full term pregnancies and whose children underwent skin prick testing (SPT) at the age of 5. Lead and mercury levels were assessed in cord blood and retested in children at age of 5 years. Aeroallergen concentrations in house dust were measured at the age of 3 years. The main health outcome (atopic status) was defined as the positive SPT to at least one common aeroallergen (Der f1, Der p1, Can f1 and Fel d1) at the age of 5 years. In the statistical analysis of the association between atopic status of children and exposure to metals, the study considered a set of covariates such as maternal characteristics (age, education, atopy), child’s gender, number of older siblings, prenatal (measured via cord blood cotinine) and postnatal environmental tobacco smoke together with exposure to polycyclic aromatic hydrocarbons (PAH) as measured by PAH-DNA adducts.
Results and conclusion
In the binary regression analysis, which controlled for the confounders, the risk ratio (RR) estimate for atopic sensitization was significantly associated with the lead exposure (RR =2.25, 95%CI: 1.21–4.19). In conclusion, the data suggest that even very low-level of prenatal lead exposure may be implicated in enhancing sensitization to common aeroallergens in early childhood.
birth cohort study; lead; intrauterine exposure; atopy; children