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Aim: The skin prick test (SPT) is the standard tool for determining respiratory allergen sensitizations. Different allergen sensitization patterns have been observed within countries and regions according to geographical and seasonal variations. This study aims to identify the sensitization pattern of children in different age groups and to define the minimum number and type of allergen extracts in an SPT to detect a sensitized child. Materials and Methods: This retrospective study was conducted in the Outpatient Clinic of the Pediatric Allergy, Immunology, and Pulmonology Unit of a tertiary Children's Hospital from October 2019 to December 2020. Children aged between 2 and 18 years suspected of inhalant allergy with the presence of clinically relevant symptoms were included. The results of SPT were collected from medical records to determine the optimal panel to cover 95% of the sensitized children. Results: A total of 1821 patients with SPT results were evaluated. Forty-three patients (2.4%) were excluded from the study because some allergen extracts did not apply. Consequently, 1778 children (male/female ratio of 1.33) were included in the study. The median age (interquartile range) was 8 years (2-18). The most common sensitizations were to grasses (Lolium perenne and Poa pratensis), trees (Olea europaea and Fraxinus excelsior), cereals (Avena sativa and Hordeum vulgare), animal dander (cat and dog), and weeds (Plantago lanceolata and Ambrosia artemisiifolia). The rate of sensitization tended to increase with age. Applying an SPT that included six allergen extracts for 2-5 years, five for 6-11 years, and four for 12-18 years was sufficient to identify 95% of sensitized children. Conclusion: A test panel with six allergen extracts was sufficient to identify most of the sensitized children and adolescents suspected of allergy and had clinically relevant symptoms. An SPT with fewer allergen sources was required to detect older sensitized children than younger children. [ABSTRACT FROM AUTHOR]

Objectives: Several allergy tests are used for the diagnosis of allergic rhinitis; however, few studies have reported a direct comparison of the skin prick test (SPT), multiple allergen simultaneous test (MAST), and ImmunoCAP according to specific allergens. This study aimed to evaluate the correlations between each test and allergic rhinitis symptoms and to evaluate the correlations of the MAST and ImmunoCAP with the SPT for representative indoor allergens in Korea. Methods: Electronic medical charts were retrospectively reviewed, and 698 patients with allergic rhinitis who had performed SPT, MAST, and ImmunoCAP were enrolled. Correlations between each allergy test for 4 representative indoor allergens and the symptoms of allergic rhinitis were analyzed. Agreements of the MAST and ImmunoCAP with the SPT were compared according to each allergen. Results: The SPT showed higher correlations with allergic rhinitis symptoms for 4 indoor allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, and dog allergens) than the MAST or ImmunoCAP. In comparison between the MAST and SPT, the least correlation was observed for the dog allergen, whereas between the ImmunoCAP and SPT, the least correlation was observed for the cat allergen. The correlation between the ImmunoCAP and SPT was higher than that between the MAST and SPT for the dog allergen, whereas no significant differences were noted for other allergens. Conclusions: Overall, the SPT showed a higher correlation with allergic rhinitis symptoms than the MAST or ImmunoCAP for 4 indoor allergens. ImmunoCAP showed similar reactivity to MAST; however, it showed better positivity with dog allergen in patients who were reactive to the allergen in the SPT. Care should be taken while evaluating dog allergen sensitization using the MAST. [ABSTRACT FROM AUTHOR]

Clinical diagnoses of asthma and reactive airway disease (RAD) in young children are subjective. We examined how often children were diagnosed with asthma versus RAD, and whether preventive care and 2-year clinical outcomes differed based on initial diagnosis. We conducted a retrospective cohort analysis of children (2–7 years) from a university-based general pediatrics practice who had been diagnosed with RAD or asthma. We performed adjusted comparisons between groups for time until subsequent asthma-related care. We also compared delivery of asthma-related healthcare services, corticosteroid and controller prescriptions, and action plans within 2 years of index diagnosis, using bivariate and regression analyses. Four hundred three children were included (64% male, 67% Black, 25% Hispanic). RAD was diagnosed in 62% of index visits, and was more likely than asthma to be diagnosed in emergency settings. In the full sample, the time between index visit and subsequent asthma care did not differ between groups, after adjustment for index location. For subjects with complete 24-month follow-up (N = 300), no between-group differences were found in adjusted analyses. Most children with RAD received action plans and controller medications only after a subsequent asthma diagnosis, on average, 9 months after their index visit. RAD diagnoses were linked to delayed delivery of preventive care measures, but within 2 years of initial diagnosis, clinical outcomes for those diagnosed with RAD and asthma did not differ. To facilitate clear communication and timely treatment, a prompt diagnosis of asthma, rather than RAD, should be considered for children with asthma symptoms. [ABSTRACT FROM AUTHOR]

Pollen allergy to Japanese cedar and cypress is a serious illness that impairs daily life and sleep, especially during pollen season. We have reported that placing a cloth panel containing a specific natural ore powder (CCSNOP) in a room may alleviate the symptoms of hay fever and may also benefit the immune system. This ore is from the Aso mountain range, a volcano on Kyushu Island in the southwestern part of Japan. The purpose of this study was to verify the effect of CCSNOP on cypress pollen. Thirty-one double-blind tests, which investigated cedar pollen allergies, were conducted from February to March 2018 and have already been reported. After this, in early April, 10 of these cases were recruited and all had CCSNOP installed in their bedrooms. Before that, various symptoms and changes in medication were recorded in a "Symptom Diary" and included a mood survey by a questionnaire, stress test using saliva amylase, changes in cypress-specific immunoglobulins IgE and IgG4 by blood sampling, and eosinophil changes. In addition, changes in 29 types of cytokines were investigated. Exposure to CCSNOP relieved symptoms and subjects decreased their intake of medication. There was no change in mood or stress, but eosinophil levels tended to decrease. Although there were no statistical changes in cypress-specific IgE or IgG4, an increase in the former and a decrease in the latter were observed in some individuals during the period of pollen dispersal. Furthermore, levels of GM-CSF and IL8 decreased significantly after use of CCSNOP. The CCSNOP was shown to be effective against cypress pollen allergy, and future investigations will be necessary to observe the long-term effects of CCSNOP. [ABSTRACT FROM AUTHOR]

Regulatory T (Treg) cells are a subtype of CD4+ T cells that play a significant role in the protection from autoimmunity and the maintenance of immune tolerance via immune regulation. Epigenetic modifications of Treg cells (i.e., cytosine methylation at the promoter region of the transcription factor, Forkhead Box P3) have been found to be closely associated with allergic diseases, including allergic rhinitis, asthma, and food allergies. In this study, we highlighted the recent evidence on the contribution of epigenetic modifications in Treg cells to the pathogenesis of allergic diseases. Moreover, we also discussed directions for future clinical treatment approaches, with a particular emphasis on Treg cell-targeted therapies for allergic disorders. [ABSTRACT FROM AUTHOR]

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Aim: Allergic sensitization in infancy generally develops against food allergens. We aimed to investigate the frequency of aero-allergens sensitization at older ages in infants with food allergy. Material and Methods: This retrospective cross-sectional study was conducted in Dr. Behçet Uz Children's Allergy Clinic. Infants with con- firmed IgE-mediated food allergy between January 1st, 2004, and December 31st, 2016, were evaluated for aero-allergen sensitivities through skin prick tests (SPT) after at least two years after diagnosis, and the data were compared with a healthy control group. Results: A total of 187 cases, 87 of which were patients, were included in the study. The cause of food allergies was cow's milk only in 24 (27.6%) cases, egg only in 26 (29.9%) cases, both cow's milk and egg in 33 (37.9%) cases, fish only in two cases (2.3%), and both fish and egg in two (2.3%) cases. The mean age at which the aero-allergen SPT was performed was 65 (46--180) months in the patient group and 72 (48--132) months in the healthy control group. In the patient group, 39 (44.8%) had aero-allergen sensitization, whereas, in the healthy control group, five (5%) had aeroallergen sensitization. Aero-allergen sensitization was more frequent in the patient group (p<0.05). There was no statistically significant difference in the type and number of food allergies and the development of aero-allergen sensitization (p>0.05). Conclusion: In infants with food allergies, sensitization may develop with aero-allergens at an early age. Clinical follow-up of these patients may be important in terms of allergic respiratory diseases. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to gather information on the current assessment and management of patients with moderate-to-severe AD in routine daily practice. Methods. A cross-sectional two-round Delphi survey with the participation of dermatologists and allergologists throughout Spain was conducted. They completed a 46-item questionnaire, and consensus was defined when responses of ≥80% of participants coincided in the categories of a 5-point Likert scale for that item. Results. A total of 105 specialists (aged 40–59 years) completed the two rounds. Participants agreed regarding the consideration of AD as a multifaceted disease and the differences in clinical presentation of AD according to the patient's age. It is recommendable to perform a skin biopsy to exclude early stage T-cell cutaneous lymphoma, psoriasis, or dermatitis herpetiformis, among others (99.1%). Also, consensus was reached regarding the use of the SCORAD index to quantify the severity of the disease (86.7%), the use of wet wraps to increase the effect of topical corticosteroids (90.4%), the usefulness of proactive treatment during follow-up (85.6%) and tacrolimus ointment (91.2%) to reduce new flares, and the fact that crisaborole is not the treatment of choice for severe AD (92.4%). AD was not considered a contraindication for immunotherapy in patients with allergic respiratory diseases (92.4%). In patients with severe AD, the use of immune response modifier drugs (97.6%) or phototherapy (92.8%) does not sufficiently cover their treatment needs. Consensus was also obtained regarding the role of the new biologic drugs (93.6%) targeting cytokines involved in the Th2 inflammatory pathway (92.0%) and the potential role of dupilumab as first-line treatment (90.4%) in moderate-to-severe AD patients. Conclusion. This study contributes a reference framework to the care of AD patients. There is no diagnostic test or biomarkers to direct treatment or to assess the severity of the disease, and many therapeutic challenges remain. [ABSTRACT FROM AUTHOR]

Background: The aim was to determine the level of inflammatory cytokines, eosinophil cationic protein and IgE in allergic rhinitis (AR) patients. Subjects and methods: Blood samples were taken from 88 AR patients and 88 healthy controls (HC). Each sample was analysed for eosinophil counts by flow cytometry, IgE by ECLIA, ECP, IL-17, and IL-33 by using ELISA test. Results: There was no significant difference between AR patients and the control group in age and gender. Levels of eosinophils, IgE, ECP, IL-17, IL-33 and the total symptom scores were significantly higher in AR patients than the HC (P = 0.0001). Serum ECP correlated with IL-17 (P = 0.041, r = 0.42), IL-33 (P = 0.0001, r = 080), and IgE levels (P = 0.017, r = 0.45) in the R patients. There was no correlation between IL-17 and IL-33. There was a correlation between symptom scores and eosinophils (P = 0.026, r = 0.52), and IgE (P = 0.001, r = 0.60) in the patients. No correlation was observed between symptom scores and ECP, IL-17, and IL-33 in the AR patient. Conclusions: Patients with AR have significant higher serum levels of ECP, IL-17, and IL-33 than healthy controls. This indicates that these markers could be used to in order to diagnose AR and to monitor disease. Inhibitory molecules to IL-17 and IL-33 may be considered as novel treatment strategies. [ABSTRACT FROM AUTHOR]

Background: The respiratory duty cycle (Ti/Ttot) can influence bronchoprovocation test results and nebulized drug delivery. The Ti/Ttot has not yet been examined in individuals with airway hyperresponsiveness (AHR) in typical bronchoprovocation test conditions. This study investigated the mean Ti/Ttot in participants with and without AHR and whether the Ti/Ttot changes with increasing bronchoconstriction.Methods: Fifteen participants with AHR and fifteen participants without AHR completed this randomized crossover study. An ultrasonic spirometer was used for continuous measurement of the Ti/Ttot as participants inhaled room air or aerosolized solution. Each participant completed two methacholine challenges, one using a continuous-output vibrating mesh nebulizer/ultrasonic spirometer and one with the nebulizer only. Prior to each methacholine challenge, participants inhaled room air and aerosolized saline through the nebulizer/spirometer setup to record baseline Ti/Ttot data.Results: The mean Ti/Ttot findings [95% CIs] during room air inhalation were 0.392 [0.378-0.406] and 0.447 [0.426-0.468] in participants with and without AHR, respectively (P < .001). The mean Ti/Ttot during saline inhalation were 0.389 [0.373-0.405] and 0.424 [0.398-0.450] in participants with and without AHR (P = .040). The Ti/Ttot showed a nonsignificant downward trend with progressive methacholine-induced bronchoconstriction.Conclusions: The mean Ti/Ttot in participants with AHR closely resembles the assumed Ti/Ttot of 0.40 recommended for standard use when calculating methacholine challenge results. Since the Ti/Ttot did not change significantly over the course of a methacholine challenge, the same Ti/Ttot can be used to calculate the dose of methacholine inhaled, regardless of the level of bronchoconstriction.Trial Registry: ClinicalTrials.gov; No.: NCT03505489; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Objective: To detect the positivity ratio of prick test and to investigate the distribution of allergens according to the age, gender, pre-diagnosis and seasons in Giresun. Methods: In this study, 330 patients undergone skin prick test in 12 month- period were included. Reviewing retrospectively, ages, genders, pre-diagnosis, seasons and results of the prick tests were noted. Ratio of test positivity and multiple allergen positivity were compared between children and adults. Results: Of 330 patients, 92 (27.9 %) had allergic rhinitis, 73 (22.1 %) had urticaria, 59 (17.9 %) had chronic cough, 50 (15.1%) had chronic pruritus, 25 (7.6 %) had atopic dermatitis, 25 (7.6 %) had contact dermatitis and 6 (1.8 %) had angioneurotic edema. Highest test positivity was evident in angioneurotic edema (83.3 %) and allergic rhinitis (65.2 %) patients. Of the patients, 106 (66.7 %) had mite sensitivity (house dust and warehouse), 44 (27.7 %) had meadow and grass pollen sensitivity, and 43 (27%) had tree pollen sensitivity. The most frequent allergen type was house dust mites in allergic rhinitis patients [D. Pteronyssnus (55%) and D. Farinae (50%)]. In children, the highest ratio of test positivity was in allergic rhinitis (72.7%) and atopic dermatitis patients (50%). No difference was evident between the ratio of test positivity and multiple allergen positivity of children and adults (X² = 0.417, p=0.519 and X² = 0.383, p=0.536; respectively). Conclusions: The most common pre-diagnosis for prick test was allergic rhinitis. Highest test positivity was in angioneurotic edema and allergic rhinitis patients. The most common allergen type was house dust mite. [ABSTRACT FROM AUTHOR]

Background: Wheat amylase trypsin inhibitors (ATI) are dietary non-gluten proteins that activate the toll-like receptor 4 on myeloid cells, promoting intestinal inflammation. Aim of the study: We investigated the effects of dietary ATI on experimental allergic airway inflammation. Methods: Mice on a gluten and ATI-free diet (GAFD), sensitized with PBS or ovalbumin (OVA) and challenged with OVA, were compared to mice on a commercial standard chow, a gluten diet naturally containing ~ 0.75% of protein as ATI (G+AD), a gluten diet containing ~ 0.19% of protein as ATI (G−AD) and a GAFD with 1% of protein as ATI (AD). Airway hyperreactivity (AHR), inflammation in bronchoalveolar lavage (BAL) and pulmonary tissue sections were analyzed. Allergic sensitization was assessed ex vivo via proliferation of OVA-stimulated splenocytes. Results: Mice on a GAFD sensitized with PBS did not develop AHR after local provocation with methacholine. Mice on a GAFD or on a G−AD and sensitized with OVA developed milder AHR compared to mice fed a G+AD or an AD. The increased AHR was paralleled by increased BAL eosinophils, IL-5 and IL-13 production, and an enhanced ex vivo splenocyte activation in the ATI-fed groups. Conclusions: Dietary ATI enhance allergic airway inflammation in OVA-challenged mice, while an ATI-free or ATI-reduced diet has a protective effect on AHR. Nutritional wheat ATI, activators of intestinal myeloid cells, may be clinically relevant adjuvants to allergic airway inflammation. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to identify of using similar screening survey approaches for asthma in children to inner-city, school-based cohort in the U.S. in 2019. It shows that asthma diagnosis can be challenging in all children, especially in minority, low-income communities with limited access to high-quality, consistent medical care where asthma prevalence can be as high as 20% to 30%.

Background: Allergic rhinitis and asthma are highly prevalent chronic inflammatory diseases leading to restrictions in the patient's quality of life and high costs for healthcare systems. Both diseases are associated with the presence of specific IgE (sIgE) against aeroallergens. This review aims to examine the importance of molecular allergy diagnostics in the assessment and management of these disorders. Content: The "U-shaped" approach, proposed by the European Academy of Allergy and Clinical Immunology, combines conventional allergy diagnostics with the benefits of component-resolved diagnosis (CRD) and offers important additional information regarding the patient's sensitization pattern, especially in complex clinical cases such as polysensitization or idiopathic reactions, thus avoiding overuse of in vitro and in vivo IgE diagnostics. CRD may help the clinician to identify the cause of an allergy and, in the case of complex polysensitization, uncover possible cross-reactivity. Polysensitization, especially to inhalant allergens, is associated with the clinical appearance of asthma and allergic rhinitis; important risk factors for the latter are the major allergens Fel d 1 and Can f 1. Importantly, information on molecular sensitization patterns significantly influences the choice of specific immunotherapy and reduces its overprescription. Conclusion: At present, allergy diagnostics largely rely on clinical history, physical examination, and in vivo IgE testing. However, in vitro diagnostics including CRD are currently finding their way into the clinical routine and can offer additional information on the patient's sensitization profile and treatment responsiveness. [ABSTRACT FROM AUTHOR]

Background: The skin prick test is recognized as the gold standard for the specific diagnosis of allergy. Objective: To determine the sensitivity and specificity of the epicutaneous patch test that has been modified for the diagnosis of respiratory allergy to Dermatophagoides pteronyssinus. Methods: An observational, interpretative, prolective, and transversal study. The included patients were between 6 and 49 years old, with symptoms of a respiratory allergy, and a skin test was performed on them by using the European standardized prick test and a modified epicutaneous patch test with the variable of the scarification that occurred before the antigen was applied, and its homogenization with a wooden applicator, which occurred after the antigen was applied. The levels of sensitivity, specificity, and prevalence influence and positive and negative predictive values were calculated. Results: 104 patients were included, of which 72 (69.2%) were women. The age category of the patients was 24 ± 11.3 years of age. 78.9% of the patients were diagnosed with allergic rhinitis, 1.9% were diagnosed with asthma, and 19.2% were diagnosed with both rhinitis and asthma. The prevalence of the respiratory allergy to Dermatophagoides pteronyssinus was of 62.5%; 94.23% with a correct diagnosis. The sensitivity and specificity of the test was of 93.85% and 94.87%; the positive and negative predictive values were of 96.83% and 90.24%, and the positive and negative likelihood ratios were of 18.30 and 0.06. Conclusions: The modified epicutaneous patch test was highly sensitive and specific; it decreased the risk of allergen carryover and it lowered the cost of the material that was used. [ABSTRACT FROM AUTHOR]

In vitro allergen-specific immunoglobulin E (sIgE) measurement has been used as an important diagnostic tool for allergic diseases. Currently, quantitative sIgE levels are detected mainly by using ImmunoCAP and Immulite 2000 assay system. These two systems have the same calibration scale at 0-100 kUA/L, but they differ in used allergens, detection methods and automation systems. We compared 1600 paired sIgE results for 204 allergic patients, including 100 paired sIgE assay results for each of 16 allergens (Alternaria alternata, birch-alder mix, cat dander, D. farinae, D. pteronyssinus, dog dander, buckwheat, crab, egg white, mackerel, milk, peach, peanut, shrimp, soybean and wheat flour). Inter-method comparison was performed for qualitative data with a cutoff of 0.35 kUA/L and a detection limit of 0.1 kUA/L, semi-quantitative class results and quantitative data. In qualitative comparisons, the overall concordance rate ranged from 81.0% to 99.0% (k: 0.599-0.949) with the cutoff value of 0.35 kUA/L. It also ranged from 80.0% to 99.0% (k: 0.521-0.951) with the detection limit of 0.1 kUA/L. The class results from these two assays showed good agreements for all allergens. For quantitative sIgE results, these two assays showed moderate positive correlations for Dog dander (r = 0.683) and Mackerel (r = 0.573) but high to very high correlations for the other 14 allergens (r = 0.734-0.972). Immulite 2000 and ImmunoCAP assays demonstrated good concordance and correlation for 16 common allergens, but international standards against each specific allergen for calibration and harmonization of sIgE tests are still needed. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the likelihood of allergic rhinitis and potential co-morbidities, and to assess whether allergic rhinitis is associated with arterial blood pressure and hypertension. Methods: In this population-based study, 369 adults with allergic rhinitis and asthma were assessed via a questionnaire and immunoglobulin E levels. There were four groups: control (n = 90), allergic rhinitis (n = 99), asthma (n = 87) and hypertension (n = 93). Arterial blood pressure was measured in all groups. Results: There were no significant differences in systolic or diastolic blood pressure between males and females in any group. Pairwise comparisons revealed no significant differences between: the control and allergic rhinitis groups, the control and asthma groups, or the allergic rhinitis and asthma groups. The systolic and diastolic blood pressure values of males and females were significantly higher in the hypertension group than the allergic rhinitis group. There were no significant differences in systolic blood pressure or diastolic blood pressure for seasonal and perennial allergic rhinitis patients. Conclusion: Rhinitis was not associated with increased blood pressure. Allergic rhinitis can coincide with asthma and hypertension. The findings do not support the need for blood pressure follow up in allergic rhinitis patients. [ABSTRACT FROM AUTHOR]

Background: The International Classification of Diseases (ICD) has been grouping the allergic and hypersensitivity disorders involving the respiratory tract under topographic distribution, regardless of the underlying mechanisms, triggers or concepts currently in use for allergic and hypersensitivity conditions. In order to strengthen awareness and deliberate the creation of the new "Allergic or hypersensitivity disorders involving the respiratory tract" section of the ICD-11, we here propose make the building process public.Methods: The new frame has been constructed to cover the gaps previously identified and was based on consensus academic reports and ICD-11 principles. Constant and bilateral discussion was kept with relevant groups representing specialties and resulted in proposals submission into the ICD-11 online platform.Results: The "Allergic or hypersensitivity disorders involving the respiratory tract" section covers 64 entities distributed across five main categories. All the 79 proposals submitted resulted from an intensive collaboration of the Allergy working group, relevant Expert working groups and the WHO ICD governance.Conclusion: The establishment of the ICD-11 "Allergic or hypersensitivity disorders involving the respiratory tract" section will allow the dissemination of the updated concepts to be used in clinical practice by many different specialties and health professionals. [ABSTRACT FROM AUTHOR]

Aim: The united airway disease (UAD) hypothesis suggests that allergic rhinitis and asthma develop together. We evaluated the evidence for and against the UAD hypothesis at five to seven years of age after hospitalisation for bronchiolitis at less than six months.Methods: This study used prospective follow-up data for 102 children hospitalised for bronchiolitis under the age of six months. We included the presence of previous and current asthma, prolonged rhinitis and skin prick tests (SPT) to common inhaled allergens and lung function by impulse oscillometry (IOS) at five to seven years of age. Bronchial hyper-reactivity (BHR) was assessed using the exercise challenge test and bronchodilation test.Results: Current asthma, but not previous transient asthma, was associated with prolonged rhinitis and a positive SPT. BHR, which reflected reactive airways, but not lung function, was associated with respiratory allergy, namely the combination of current asthma, prolonged rhinitis and a positive SPT.Conclusion: This post-bronchiolitis follow-up study suggested an association between respiratory allergy and reactive airways at five to seven years of age, which supported the UAD hypothesis. However, previous transient asthma and a reduction in lung function reduction did not support the hypothesis. [ABSTRACT FROM AUTHOR]

Respiratory allergy triggered by exposure to environmental chemical allergen is a serious problem in many Asian countries and has the potential to cause severe health problems. Here, we aimed to elucidate the pathogenic mechanisms of this disease and develop anin vivodetection method for respiratory allergy induced by environmental chemical allergen. Both BALB/c and NC/Nga mice were sensitized topically for 3 weeks and were then subjected to inhalation challenge with pulverized trimellitic anhydride into particles measuring 2-μm in diameter. On the day after the final challenge, all mice were sacrificed, and IgE levels, immunocyte counts, and cytokine levels in the serum, hilar lymph nodes, and bronchoalveolar lavage fluid were measured. We also monitored the expression of genes encoding pro-inflammatory cytokines in the lung. We found that all endpoints were significantly increased in mice of both strains subjected to trimellitic anhydride inhalation as compared with the respective control groups. However, worsening of respiratory status was noted only in NC/Nga mice. Interestingly, type 2 helper T-cell reactions were significantly increased in BALB/c mice compared with that in NC/Nga mice. In contrast, the number of mast cells, levels of mast cell-related cytokine/chemokines, and production of histamine in NC/Nga mice were significantly higher than those in BALB/c mice. Thus, environmental chemical allergen induced respiratory allergy in NC/Nga mice in terms of functional and inflammatory symptoms. Furthermore, mast cells may be involved in the aggravation of airway allergic symptoms induced by environmental chemical allergens. [ABSTRACT FROM AUTHOR]

IgE-mediated allergy to wheat proteins can be caused by exposure through ingestion, inhalation, or skin/mucosal contact, and can affect various populations and age groups. Respiratory allergy to wheat proteins is commonly observed in adult patients occupationally exposed to flour, whereas wheat food allergy is more common in children. Wheat allergy is of growing importance for patients with recurrent anaphylaxis, especially when exercise related. The diagnosis of wheat allergy relies on a consistent clinical history, skin prick testing with well-characterized extracts and specific IgE tests. The accuracy of wheat allergy diagnosis may be improved by measuring IgE responses to several wheat components. However, a high degree of heterogeneity has been found in the recognition pattern of allergens among patient groups with different clinical profiles, as well as within each group. Thus, oral provocation with wheat or the implicated cereal is the reference test for the definitive diagnosis of ingested wheat/cereal allergy. [ABSTRACT FROM AUTHOR]

Allergic rhinitis is an IgE hypersensitivity reaction that takes place in the nasal mucosa because of the inhaled allergens. Skin prick tests and serum specific IgE (sIgE) measurements are recommended to diagnose AR on first steps. In this study, sensitive allergen profile and the detected levels of sIgE were investigated in adult patients with AR. Medical records of 426 adult patients with AR were reviewed retrospectively. 148 (63 male, 85 female) of them who showed significant serum sIgE levels as a reaction to at least one agent were enrolled in the study. Serum sIgE measurements were performed with enzyme immunoassay method. 20 parameters were scanned in tests. According to antibody levels, 10 patients were sensitive to one allergen, 138 patients were found to be sensitive to more than one allergen. The maximum sensitivity rate was 44.6% against to dog epithelium, while the least was 0.7% to molds. Antibody levels were found to be higher as the numbers of sensitizing allergen levels were increased. [ABSTRACT FROM AUTHOR]

Allergic rhinitis is a major chronic respiratory disease and an immunoneuronal disorder. We aimed at providing further knowledge on the function of the neural system in nasal allergic reaction. Here, a method to assess simultaneously the nasal airflow resistance and the underlying function of autonomic nervous system (ANS) is presented and used during the nasal provocation of allergic and nonallergic subjects. Continuous nasal airflow resistance and spectral heart rate variability parameters show in detail the timing and intensity differences in subjects’ reactions. After the provocation, the nasal airflow resistance of allergic subjects showed a positive trend, whereas LF/HF (Low Frequency/High Frequency) ratio and LF power showed a negative trend. This could imply a gradual sympathetic withdrawal in allergic subjects after the allergen provocation. The groups differed significantly by these physiological descriptors. The proposed method opens entirely new opportunities to research accurately concomitant changes in nasal breathing function and ANS. [ABSTRACT FROM AUTHOR]

Background: Sputum is a key diagnostic sample for those with chronic chest conditions including chronic and allergic aspergillus-related disease, but often not obtained in clinic. The objective of this study was to evaluate physiotherapeutic interventions to obtain sputum from those not able to spontaneously produce and the subsequent microbiological result.Methods: Sputum samples were collected by physiotherapists from patients attending routine outpatient clinics managing their aspergillus-related diseases who were unable to spontaneously produce. Active Cycle of Breathing Techniques (ACBT) technique was applied first, for 10 min, followed by hypertonic saline induction using a Pari LC plus or Pari Sprint nebuliser, if necessary and deemed safe to do so. Samples processed in the laboratory using standard microbiological techniques for bacterial and fungal culture with the addition of Aspergillus real-time PCR.Results: Samples were procured from 353 of 364 (97%) patients, 231 (65%) by ACBT and 119 (34%) with administration of hypertonic saline. Three of 125 (2.4%) patients had significant bronchospasm during sputum induction. Sixteen patients' sputum tested positive for Aspergillus culture, contrasting with 82 whose Aspergillus PCR was positive, 59 with a strong signal. PCR improved detection of Aspergillus by 350%. Sputum from 124 (34%) patients cultured other potentially pathogenic organisms which justified specific therapy.Conclusions: Physiotherapeutic interventions safely and effectively procured sputum from patients unable to spontaneously produce. The method for sputum induction was well-tolerated and time-efficient, with important microbiological results. [ABSTRACT FROM AUTHOR]

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis ( MACVIA- ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology ( ICT) tools and a clinical decision support system ( CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity ( ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing ( EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale ( VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system ( CDSS) and are available in many languages. An e- CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is associated with food allergies. The aim of this study is to evaluate soy allergy in patients suffering from atopic dermatitis. Altogether 228 persons were included; specific IgE, skin prick tests, atopy patch tests, challenge tests with soy and history of soy allergy were evaluated. Soy allergy was confirmed in eight patients (3.5%, in four patients with worsening of atopic dermatitis, in four patients with oral allergy syndrome), sensitisation to soy was found in another 47 patients (20%) with no clinical manifestation after soy ingestion. Dependence was confirmed statistically between soy allergy and pollen allergy and soy sensitivity and pollen allergy. About 20% of patients suffering from atopic dermatitis are sensitised to soy. Clinical symptoms of soy allergy occur only in 3.5% of patients suffering from atopic dermatitis. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20-30% of the world's population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. Methods: In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007-2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. Results: Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium ( p = 0.01) and Penicillium ( p = 0.005) and between cough and seropositivity for Aspergillus ( p = 0.007). Conclusions: Anti- Penicillium (79.7%) and anti- Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy. [ABSTRACT FROM AUTHOR]

The authors offer perspectives on reactive airways disease or really asthma disease (RAD) in pediatrics. Topics include how RAD began and how it persisted, several practical problems with using the nondiagnostic term RAD, and a call for the abandonment of the term RAD along with its counterparts asthma-like symptoms and recurrent wheeze.

Background Knowledge of our immune system functions is critical for understanding allergic airway disease development as well as for selection of appropriate diagnostic and therapeutic options for patients with respiratory allergies. Methods This review explains the current understanding of the basic immunology of the upper airways and the pathophysiology of allergic responses, including the mechanisms behind allergic rhinitis. Results The immune system can be divided to 2 main defense systems that function differently-innate immunity and adaptive immunity. Innate immunity includes several defensive mechanisms such as anatomic or physical barriers, physiological barriers, phagocytosis, and inflammation. The adaptive immune response is activated in an antigen-specific way to provide for the elimination of antigen and induce lasting protection. Hypersensitivity reactions occur when an exaggerated adaptive immune response is activated. Allergic rhinitis is an example of a type I, immunoglobulin E, mediated hypersensitivity reaction. Conclusion Today we have several immunomodulatory treatment options for patients with allergic airway diseases, such as subcutaneous and sublingual immunotherapy. An understanding of the basics of our immune system and its method of functions is key for using these therapies appropriately. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory allergic disorders like rhinitis and asthma are common conditions that not only affect target organs, but complicate the daily life of affected children and adolescents. Objectives: The aim of this study was to investigate the QoL (quality of life) in children with grass pollen allergy in and out of grass pollen season. Methods: We used the Pediatric Allergic Disease Quality of Life Questionnaire (PADQLQ), a disease-specific questionnaire including both asthma and rhinitis symptoms. We also used the DISABKIDS (a European project which aims at enhancing the quality of life and the independence of children with chronic health conditions and their families) questionnaire, a generic questionnaire covering non-organ-specific effects of disease. Results: Ninety-eight children 7-18 years old with grass pollen allergy were included. Eighty-nine children (91%) completed the study. The QoL was significantly decreased during pollen season assessed both with DISABKIDS and PADQLQ. The correlation between the questionnaires was 0.73. Not only the physical domain score ( P = 0.00093) but also the emotional domain score ( P = 0.034) was significantly lowered. Children with multiple manifestations (asthma and rhinitis) had lower QoL than children with rhinitis alone ( P = 0.01). Multiple regression analysis showed a highly significant impact on QoL for symptoms from nose, eyes and lungs. They were equally important (standardized coefficient 047, 0.47 and 0.46, respectively). Conclusion: The QoL in children and adolescents with respiratory allergy deteriorates during pollen season. This was shown both with generic (DISABKIDS) and disease-specific instrument (PADQLQ). Please cite this paper as: Kiotseridis H, Cilio CM, Bjermer L, Aurivillius M, Jacobsson H, Dahl Å and Tunsäter A. Quality of life in children and adolescents with respiratory allergy, assessed with a generic and disease-specific instrument. Clin Respir J 2013; 7: 168-175. [ABSTRACT FROM AUTHOR]

Allergic respiratory disorders are fairly common visiting cases in pediatrics outpatient department (OPD). With an appropriate history and detailed examination, diagnosis may not be problematic. Routine investigation may not contribute much to the final diagnosis but may help in ruling out other possibilities. This study was done to evaluate sensitivity and specificity of blood or nasal eosinophilia in subjects suffering from allergic respiratory disorders and also to assess the feasibility of nasal cytogram which is a simple, economical and reliable investigation in allergic respiratory disorders. This is a prospective clinical correlation study of patients attending outpatient department. 100 subjects aged between 2-18 years of either sex were selected for the estimation of eosinophil count in nasal and peripheral smear in allergic respiratory disorders. All allergic respiratory cases based on eosinophillia. The nasal and blood eosinophilia were compared with each other and clinical findings of allergic rhinitis with or without asthma were studied. In this study peak age incidence was seen between 11-18 years and it was more common in males. Rhinorrhoea, pale mucosa and nasal obstruction were common findings in allergic rhinitis with bronchial asthma. Nasal eosinophilia was seen in 52.4% and 64.9% of cases of allergic rhinitis and allergic rhinitis with asthma respectively. Blood eosinophilia was seen in 54% and 56.8% of cases of allergic rhinitis with asthma respectively. Nasal cytogram which is a simple, economical a n d non- invasive procedure can be used as an alternative to invasive peripheral smear eosinophilia as both are equally efficacious in diagnosing allergic respiratory diseases. [ABSTRACT FROM AUTHOR]

Background: The prevalence of allergic rhinitis due to house-dust mites (HDMs) is high and increasing. Treatment guidelines and consensus statements are available, but few data exist on how these are followed in clinical practice in Spain. This study was designed to collect data on diagnosis and treatment of allergic rhinitis due to HDMs and adherence to guidelines in Spanish specialized clinical practice. Methods: In this observational study, patients referred to specialists for a first consultation were collected. Diagnosis of allergic rhinitis due to HDMs was confirmed by skin-prick tests and measurement of specific immunoglobulin E levels. Variables included patient demographics, diagnosis, and treatment. Moreover, investigators answered a questionnaire on their attitudes to allergic rhinitis treatment. Results: Two hundred forty-seven clinicians collected evaluable data from 519 patients (mean age, 24.8 years; SD, 11.9 years; 54% women) with confirmed allergic rhinitis (86.2% with moderate or severe disease and 70.5% with persistent disease; 40% with concomitant asthma) caused by Dermatophagoides. In 85.6% of patients, symptoms had not improved since diagnosis and good disease control was only being achieved in 43.4%. At the study visit, pharmacologic treatment was prescribed in 98.3% and allergen immunotherapy was prescribed in 52.2% of patients. Conclusion: When patients with HDM-induced allergic rhinitis are referred to an allergy specialist in Spain, they have moderate-to-severe persistent disease and are generally not achieving good control with symptomatic treatment. Allergen immunotherapy is prescribed in approximately one-half of patients. In this representative sample of Spanish allergy specialists, the level of adherence to clinical guidelines in these patients is encouraging. [ABSTRACT FROM AUTHOR]

Background: The Allergies in Asia-Pacific Survey describes the symptoms, impact, and treatment of allergic rhinitis (AR) across Australia, China, Hong Kong, Malaysia, Singapore, Taiwan, Vietnam, and the Philippines. The Allergies in Asia-Pacific Survey was undertaken to further clarify the prevalence of physician-diagnosed nasal allergies (NAs), impact on quality-of-life (QOL), existing treatment paradigms and gaps, and NA medications currently used in treatment. Methods: Thirty-three thousand three hundred seventy-eight households were screened for individuals, ≥4 years old, with a physician diagnosis of AR or NA and either symptoms or treatment in the past 12 months. Standardized questionnaires were used to make comparisons across regions. A total of 1043 adults and 192 children were included in the survey. Results: Nine percent of participants were diagnosed with AR with two of three responding that their NAs were seasonal in nature. Nasal congestion was the most common and bothersome symptom of AR. Most participants reported that AR impacted their QOL with nearly one-half citing impairments in school/work performance/productivity. Sleep disturbances, secondary to AR, were also shown to be appreciable. Two-thirds of patients took medication for their AR. Less than one-quarter of survey respondents reported taking an intranasal corticosteroid and the satisfaction rate was similar to that of over-the-counter medications. The most common reasons cited for dissatisfaction were related to inadequate efficacy and bothersome side effects. Conclusion: AR appears to be extremely common across Asia-Pacific nations. Many individuals with AR suffer from symptoms that reduce QOL and treatment gaps exist with current therapies. Through identification of disease impact and highlighting treatment gaps, clinicians may better understand and treat AR, leading to improvements in overall patient satisfaction and QOL. [ABSTRACT FROM AUTHOR]

Reactive airways dysfunction syndrome (RADS) is an asthma-like illness that develops after a single high-level exposure to a pulmonary irritant. Two different cases are reviewed, in which the exposure circumstances were not sufficient to result in adverse health effects yet resulted in persistent respiratory symptoms and a clinical diagnosis of RADS. Potential explanations for an erroneous diagnosis of RADS included an incomplete exposure assessment, medication adverse effects that can contribute to respiratory symptoms, and alternative explanations for respiratory symptoms or test findings. In particular, the empirical use of bronchodilator medications without a clear indication appeared to contribute to continued respiratory symptoms. Without a clear understanding of the patient's exposure, a RADS diagnosis should be carefully considered. The possibility of an iatrogenic sequence of events in which medication adverse effects facilitate respiratory symptoms and a mistaken RADS diagnosis should be considered, particularly in patients who have a poorly defined exposure history. [ABSTRACT FROM AUTHOR]

The frequency of adults reporting a history of asthma is rising. However, it is unclear whether this increased prevalence accurately demonstrates a rising trend or if it reflects an overall increase in asthma awareness. To determine the frequency of negative methacholine bronchoprovocation tests in adults who report physician-diagnosed asthma and to explore the clinical characteristics of subjects with negative tests. Data from methacholine challenge, spirometry, and physician assessment were analysed from 304 adults who reported physician-diagnosed asthma and responded to community-based advertising for asthma research studies. The clinical characteristics of methacholine-positive and -negative subjects were compared and a predictive model was tested to identify those characteristics associated with a negative test. Of the 304 subjects tested, 83 (27%) had a negative methacholine test. A negative test was positively associated with an adult-onset of symptoms ( P<0.001), normal forced expiratory volume in 1 s ( P<0.001), and having no history of exacerbation requiring oral steroids ( P=0.03). Over half (60%) of those with a negative test reported weekly asthma-like symptoms (cough, dyspnoea, chest tightness, or wheeze), while 39% reported emergency department visits for asthma-like symptoms. A sizeable percentage of subjects who report physician-diagnosed asthma have a negative methacholine challenge test. These subjects are characterized by diagnosis of asthma as an adult and by normal or near normal spirometry. Caution should be exercised in the assessment and diagnosis of adults presenting with asthma-like symptoms, because they may not have asthma. Further diagnostic studies, including bronchoprovocation testing, are warranted in this patient group, especially if their spirometry is normal. Cite this as: K. W. McGrath and J. V. Fahy, Clinical & Experimental Allergy, 2011 (41) 46-51. [ABSTRACT FROM AUTHOR]

Background/purpose: Pollen allergy is believed to be less common in East Asia, Latin America, and tropical areas. The purpose of this study was to understand the role of pollen allergy in Taiwan.Methods: Patients with clinically diagnosed allergic rhinitis were enrolled. All subjects received a 30-item skin test panel that included perennial allergens (house dust mix, Dermatophagoides pteronyssinus, Dermatophagoides farinae, dog epithelium, cat hairs, cockroach mix, and Candida albicans) and pollen allergens (acacia, pine mix, eucalyptus, beefwood, juniper mix, willow, mulberry mix, pepper tree, cedar, Johnson grass, Bermuda grass, ragweed mix, Timothy grass, spiny pigweed, cocklebur, sage mix, sheep sorrel, dog fennel, pigweed mix, English plantain, castor bean, alfalfa, and dandelion).Results: A total of 419 patients were recruited. A total of 313 (74.7%) had a positive skin test. A total of 288 patients (68.7%) were sensitive to perennial allergens, and 11 8 patients (28.2%) were sensitive to pollen allergens. However, 93 pollen-sensitive patients were also sensitive to perennial allergens, and only 25 were sensitive to pollen allergens alone. The most common allergens were D. pteronyssinus, D. farinae, house dust mix, and cockroach, but the most common pollen allergens were spiny pigweed, Johnson grass, and sheep sorrel. All nasal symptoms tended to be more severe in patients who were sensitive to perennial allergens than in those who were sensitive to pollen allergens alone.Conclusion: Most patients with allergic rhinitis in Taiwan are sensitive to perennial allergens, and pollens are a less common allergen. [ABSTRACT FROM AUTHOR]

AbstractBackground:Inadequate technique reduces the effects of inhalation medication. Errors in inhalation technique have been reported to range up to 85%. Not only various patients'' characteristics but also the device has an effect on correct inhalation technique. The purpose of this study was to determine the effect of patients'' characteristics and type of inhaler device on inhalation technique in patient with asthma or chronic obstructive pulmonary disease (COPD).Methods:A validated scoring method was used that consisted of triple viewing of video-recorded inhalations, using device-specific checklists. The following patient characteristics were investigated: gender, age, education level, diagnosis, treatment by a pulmonary physician, previously received inhalation instruction, exacerbation frequency, knowledge, self-management competence, pulmonary function, and use of multiple inhaler devices. Chi-square statistics were used for univariate associations between potential determinants and correctness of inhalation technique. Relevant determinants were entered into a multivariate logistic regression model. Moreover, inhalation technique errors were examined for six inhaler devices: three prefilled dry powder inhalers, one single-dose dry powder inhaler, a pressurized metered-dose inhaler (pMDI) and a pMDI with a spacer.Results:Overall, 40% of the patients made at least one essential mistake in their inhalation technique. Patients who never received inhalation instruction and patients who used more than one inhaler device made significantly more errors (odds ratio both 2.2). Comparison between devices showed that a correct inhalation technique most likely occurred with the use of prefilled dry powder devices.Conclusion:Incorrect inhalation technique is common among asthma and COPD patients in a pulmonary outpatient clinic. Our study suggests that the use of prefilled dry powder inhalers as well as inhalation instruction increases correct inhalation technique. Simultaneous use of different types of inhalation devices has to be discouraged. [ABSTRACT FROM AUTHOR]

The atopy patch test (APT) was recently defined as an important tool in diagnosis of atopic dermatitis (AD) and also of rhinitis and asthma caused by hypersensitivity to the house dust mites. We evaluated 465 children (279 males and 186 females) aged 0.4-17.6 years (mean 6.6 +/- 3.8 years), by dividing them into four groups: group A, current AD (40 patients); group B, current AD with respiratory symptoms (156 patients); group C, past AD with respiratory symptoms (203 patients); and the control group, respiratory symptoms with no history of AD (66 patients). The APT was significantly more frequently positive in groups with current AD (groups A and B) or past AD (group C) than in the control group, while skin prick test (SPT) and radioallergosorbent test (RAST) were significantly more frequently positive in the control group. With multivariate analysis, for APT, significant differences were found in the comparison between group A vs group B (odds ratio (OR) 1.55) and between group A vs group C (OR 1.81). The mean age was significantly lower in group A than in groups B, C, and the control group and with less significance in groups C vs D. Children sensitized to mites with current or past AD, with or without respiratory symptoms, have a different response to diagnostic tests, which is characterized by a highly significantly more frequent positive APT in comparison with subjects who have respiratory symptoms but a negative history for AD, who show the common response to SPT and RAST. [ABSTRACT FROM AUTHOR]

Background: The frequency of sensitization to cats in patients with respiratory allergy may be as high as 60% and is a risk factor for developing cat allergy. Objective: To establish the frequency of sensitization to cats by environmental exposure and skin test to cat allergen Fel d 1 in patients with respiratory allergy. Methods: Prospective comparative cross-sectional study conducted from August to November 2009. One hundred ninety eight subjects divided into 2 groups (A group of 98 patients with respiratory allergy and a group of 100 healthy controls). Were included an epidemiological questionnaire and a clinical skin test to cat allergen Fel d 1 (1:20 w / v) by means of a epicutaneous prick (Prick-test) were applied. Results: The frequency of sensitization to cat measured by skin testing patients with respiratory allergy was 25% compared to 10% in healthy subjects (p = 0.004). In subjects with allergic rhinitis and asthma the frequency of sensitization to cat was 31%, whereas in subjects who had only allergic rhinitis was 22% (p = 0,416). The presence of symptoms after environmental exposure to cat in patients with respiratory allergy was 19%, in healthy subjects was 2% (P <0.001). The presence of cat at home in patients with respiratory allergy and positive to cat allergen on skin testing was 1%. Cat-sensitive patients had a frequency of sensitivity to other allergens such as D. pteronyssinus (80%); D.farinae (72%); Cynodon (52%); Amarantus, Salsola and Fraxinus (40%). Conclusion: The frequency of sensitization to cat allergen in patients with respiratory allergy was 25%, similar to that reported on other series. [ABSTRACT FROM AUTHOR]

Background Airway hyperresponsiveness (AHR) in asthmatics includes a variable component that persists following an allergen challenge. This may be dissociated from inflammatory cell recruitment, implying a role for resident pulmonary cells in regulating the response. Objective Using improved methods of assessing AHR in a mouse model of allergic airway disease, to investigate the basis of the development of prolonged AHR. Method BALB/c mice were systemically sensitized and then challenged with aerosolized ovalbumin (OVA). Airway and tissue responsiveness were measured at baseline and at 1 day, and 1, 2 and 3 weeks after the last OVA challenge. Inflammatory cell numbers in BALF and levels of mRNA for eotaxin-1 and -2, IFN-γ, IL-5 and -13 in the lung were measured at each time-point. In further experiments, the roles of IFN-γ and of CCR3+ and CD4+ cells in the development of prolonged AHR were assessed by blockade or depletion with monoclonal antibodies. The role of pulmonary macrophages was assessed by selective chemical depletion of these cells. Results Airway responsiveness was increased above baseline at 1 day after the last OVA challenge, and this was sustained for 1 week. In contrast, tissue-specific responsiveness was only significantly increased above baseline at 1 day. Development of prolonged AHR was inhibited by neutralization of IFN-γ or by depletion of pulmonary macrophages, but not by depletion of either CD4+ T cells or CCR3+ eosinophils. Conclusion An interaction between IFN-γ and pulmonary macrophages contributed to the prolongation of airway hyperresponsiveness. In contrast, T cells and eosinophils did not contribute to prolongation of AHR. These findings emphasize the importance of the innate host response in the development of manifestations of asthma, as well as its potential relevance as a target for therapeutic intervention. Cite this as: M. Yang, R. K. Kumar and P. S. Foster, Clinical & Experimental Allergy, 2010 (40) 163–173. [ABSTRACT FROM AUTHOR]

Renal arteriovenous fistulas (AVFs) are an uncommon complication of nephrectomy. In this report, we present the case of a 66-year-old female presenting with progressive dyspnea on exertion and exercise intolerance. She was diagnosed and treated for adult onset reactive airway disease. The patient underwent nephrectomy at age 18 secondary to recurrent pyelonephritis from vesicoureteral reflux. She underwent a surveillance computed tomography (CT) scan to evaluate a small ascending aneurysm that was initially detected on cardiac echocardiogram. A large left renal AVF was detected incidentally on the CT scan. The fistula was successfully treated by ligation of the renal artery with resolution of pulmonary symptoms. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Because asthma disproportionately affects minorities, we evaluated the effects of parent mentors (PMs) on asthma outcomes in minority children. METHODS: This randomized, controlled trial allocated minority asthmatic children to the PM intervention or traditional asthma care. Intervention families were assigned PMs (experienced parents of asthmatic children who received specialized training). PMs met monthly with children and families at community sites, phoned parents monthly, and made home visits. Ten asthma outcomes and costs were monitored for 1 year. Outcomes were examined by using both intention-to-treat analyses and stratified analyses for high participants (attending 25% of community meetings and completing 50% of PM phone interactions). RESULTS: Patients were randomly assigned to PMs (n = 112) or the control group (n = 108). In intention-to-treat analyses, intervention but not control children experienced significantly reduced rapid-breathing episodes, asthma exacerbations, and emergency department (ED) visits. High participants (but not controls or low participants) experienced significantly reduced wheezing, asthma exacerbations, and ED visits and improved parental efficacy in knowing when breathing problems are controllable at home. Mean reductions in missed parental work days were greater for high participants than controls. The average monthly cost per patient for the PM program was $60.42, and net savings of $46.16 for high participants. CONCLUSIONS: For asthmatic minority children, PMs can reduce wheezing, asthma exacerbations, ED visits, and missed parental work days while improving parental self-efficacy. These outcomes are achieved at a reasonable cost and with net cost savings for high participants. PMs may be a promising, cost-effective means for reducing childhood asthma disparities. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We evaluated the longitudinal effects of home-based asthma education combined with medication adherence feedback (adherence monitoring with feedback [AMF]) and asthma education alone (asthma basic care [ABC]) on asthma outcomes, relative to a usual-care (UC) control group. METHODS: A total of 250 inner-city children with asthma (mean age: 7 years; 62% male; 98% black) were recruited from a pediatric emergency department (ED). Health-outcome measures included caregiver-frequency of asthma symptoms, ED visits, hospitalizations, and courses of oral corticosteroids at baseline and 6-, 12-, and 18-month assessments. Adherence measures included caregiver-reported adherence to inhaled corticosteroid (ICS) therapy and pharmacy records of ICS refills. Multilevel modeling was used to examine the differential effects of AMF and ABC compared with UC. RESULTS: ED visits decreased more rapidly for the AMF group than for the UC group, but no difference was found between the ABC and UC groups. The AMF intervention led to short-term improvements in ICS adherence during the active-intervention phase relative to UC, but this improvement decreased over time. Asthma symptoms and courses of corticosteroids decreased more rapidly for the ABC group than for the UC group. Hospitalization rates did not differ between either intervention group and the UC group. No differences were found between the ABC and AMF groups on any outcome. CONCLUSIONS: Asthma education led to improved adherence and decreased morbidity compared with UC. Home-based educational interventions may lead to modest short-term improvements in asthma outcomes among inner-city children. Adherence feedback did not improve outcomes over education alone. [ABSTRACT FROM AUTHOR]

Objective:Whether or not individuals with allergy and asthma experience different patterns of change in the balance of both pro- and anti-inflammatory mediators with acute exercise is not known. We hypothesized that adolescent swimmers with a clinical diagnosis of respiratory allergy would have an exaggerated proinflammatory response to laboratory exercise relative to a no-allergy comparison group.Methods:Adolescent swimmers (17 with clinical symptoms of respiratory allergy (CSRA) and 17 in comparison group) completed the American Thoracic Society (ATS) exercise challenge on cycle ergometer. Blood was collected at baseline and immediately post-exercise. All study tests were conducted at the Institute for Clinical Translational Science at the University of California, Irvine. Circulating cytokines, growth factors, and adhesion molecules were measured using ELISAs including transforming growth factor-1 (TGF-β1), tumor necrosis factor- (TNF-α), interleukin-4 (IL-4), IL-6, IL-10, P-selectin, and immunoglobulin E (IgE).Results:There was a trend toward higher resting levels of TNF-α in the CSRA group (P 0.076). Exercise induced a significant increase in P-selectin and TGF-α1 in both groups. TNF-α increased significantly (17) in the comparison group (pre 0.6, post 0.7 pg/mL), but not in the CSRA group. IL-6 increased significantly in the CSRA group (pre 0.7, post 0.8 pg/mL), but not in the comparison group. Circulating levels of IL-4 and IL-10 were not altered immediately post-exercise in either group.Conclusions:A short bout of intense exercise increased inflammatory growth factors and adhesion molecules, namely TGF-β1 and P-selectin, both of which are known to be involved in allergic airway diseases. Differences in resting IL-6 and TNF-α and exercise alterations in these cytokines may also contribute to allergic disease in adolescent elite swimmers. [ABSTRACT FROM AUTHOR]

Background: Helper T (Th) cells are deeply involved in the pathophysiology of bronchial asthma, such as eosinophilic inflammation, bronchial hyperresponsiveness and remodeling. However, it is still unclear how Th cells contribute to airflow limitation, another cardinal feature of bronchial asthma. Method: Unprimed BALB/c mice were transferred with ovalbumin (OVA)-reactive Th clones. Pulmonary function was monitored using a Buxco BioSystem Plethysmograph before and after OVA challenge. Results: When Th-transferred mice were challenged with OVA, enhanced pause (Penh), an indicator of airflow limitation was significantly increased 6 and 24 h after challenge, while no response was observed 30 min after challenge. Neither bovine serum albumin, an irrelevant antigen, challenge on Th-transferred mice nor OVA challenge on Th-non-transferred mice caused airway responses. Conclusion: Th cells conferred antigen-induced airflow limitation to unprimed mice. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Osteopontin (OPN) contributes to the development of T helper 1 (Th1)-mediated immunity and Th1-associated diseases. However, the role of OPN in bronchial asthma is unclear. Corticosteroids reduce airway inflammation, as reflected by the low eosinophil and T-cell counts, and the low level of cytokine expression. We investigated OPN production and the inhibitory effects of corticosteroids on OPN production in a murine model of allergic asthma. Methods: BALB/c mice were sensitized by intraperitoneal injections of ovalbumin (OVA) with alum. Some mice received daily injections of dexamethasone (DEX) or phosphate-buffered saline for 1 week. All OVA-challenged mice were exposed to aerosolized 1% OVA for 30 min an hour after these injections. After the OVA challenge, the mice were killed, and bronchoalveolar lavage (BAL) fluid and lung tissue were examined. Results: The levels of OPN protein in BAL fluid and OPN mRNA in lung tissue increased after OVA challenge. Most OPN-expressing cells were CD11c+ cells and some were T cells. DEX decreased the levels of OPN protein in the BAL fluid, and those of OPN mRNA and OPN protein in lung tissue. Conclusions: OPN may play an important role in allergic bronchial asthma. Corticosteroids inhibit OPN production in mice with allergic asthma. The beneficial effect of corticosteroids in bronchial asthma is partly due to their inhibitory effects on OPN production. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses the difficult challenges associated with treating adult asthma. Key questions that need to be answered before prescribing additional treatments or increased steroid doses include proper asthma diagnosis, the assessment of coexisting conditions that exacerbate asthma, and what aggravating factors might be considered. Other relevant topics addressed include risk factors such as upper airway disease, gastro-oesophageal reflux disease, and adverse drug effects. The potential reasons why some patients may not adhere to asthma treatments are analyzed.

The objective of this study is to investigate the relationship between five air pollutants (PM10, SO2, NO2, O3, CO) measured on the daily basis, and adverse health symptoms using epidemiological surveillance data. The generalized estimated equation (GEE) model, a logistic regression analysis model, was used to estimate the effects of air pollution on children's daily health symptoms, focusing on the morbidity including both respiratory and allergic symptoms in four different cities. Analysis of the effects of each pollutant on children's respiratory and allergic symptoms demonstrated that CO affected all symptoms in all the study areas. When the concentration of SO2 and NO2 was elevated, upper respiratory symptoms increased significantly. In contrast, when the concentration of O3 rose, the symptoms decreased significantly. The relationship between measured concentrations and health symptoms was site-dependent for each pollutant. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 10-year-old patient with cystic fibrosis, tacrolimus treatment after liver transplantation, and persistent biphasic stridor, revealing a vallecular cyst and a subglottic mass with subtotal laryngeal stenosis. His endoscopy was done for laser resection of mass and marsupialization of vallecular cyst. His histological examination showed cell detritus, mucus with aggregates of eosinophil granulocytes, Charcot-Leyden crystals, and fragments of epithelium.