Practical guide to skin prick tests in allergy to aeroallergens

Characteristics of pollen-related food allergy based on individual pollen allergy profiles in the Chinese population

Background

Patients with pollinosis are often multi-sensitized to diverse pollen allergens. However, little is known about pollen allergy types among Chinese pollinosis patients. This study is aimed to characterize clinical manifestations of food allergy among patients with different types of pollen allergy.

Methods

We retrospectively analyzed 402 pollinosis patients from an outpatient allergy department of the Peking Union Medical College Hospital who had been diagnosed by experienced allergists. All included patients who answered a questionnaire regarding seasonal pollinosis and clinical symptoms after ingestion of food and underwent intradermal skin tests. Total IgE and specific IgE levels were quantified by ImmunoCAP, using 0.35 kUA/L as a threshold for positivity.

Results

The patients were divided into 3 groups, based on the season during which they experienced symptoms and the 2 peaks of Chinese airborne pollen: spring-tree pollen symptoms group (SG), autumn-weed pollen symptoms group (AG), and a combined spring and autumn pollen symptoms group (CG). Birch pollen (83%) and ash pollen (74%) were common allergens among patients with spring symptoms, while mugwort pollen (87%) was a common allergen among patients with autumn symptoms. In total, 30% of the study population experienced pollen-related food allergy. Pollen-related food allergies were more prevalent among the single-season symptom groups (68% and 50% for the SG and AG, respectively) than among the CG (20%). All patients with pollen-related food-induced anaphylaxis exhibited autumn weed pollen symptoms. Except for 2 patients, all patients with food-induced anaphylaxis were allergic to mugwort pollen. In the SG, all patients with food allergy were sensitive to birch pollen, with birch and Bet v 1-specific IgE levels higher in this group than in the group without food allergy (p < 0.001). In the AG, Art v 3 was more prevalent among patients with pollen-related food allergy than without food allergy (79% vs. 33%, p < 0.001), a proportion similar to the one in the CG (67% vs. 48%, p = 0.01). Meanwhile, the Art v 3-specific IgE levels among patients with pollen-related food allergy were higher than among tolerant patients in the AG (p < 0.001) and CG (p = 0.02). Unexpectedly, the Art v 3-specific IgE levels were higher in patients with food-induced anaphylaxis than with oral allergy syndrome only in the CG.

Conclusions

Bet v 1 (a Pathogenesis-related 10 protein) and Art v 3 (a non-specific lipid transfer protein; nsLTP) are candidate molecular biomarkers for the diagnosis of food allergies in patients with season-specific pollen-related allergies. Measuring pollen allergen component-specific IgE levels might be an effective tool for the management of pollinosis in clinical practice in China.

"Severe-controlled" asthma 4 years later: is it still controlled?

BACKGROUND

Controlled severe asthma is based on needing regular medication and 4 markers of good asthma control. This study reevaluated a community sample defined 4 years earlier as "severe-controlled" based on electronic medical records of medications dispensed over 12 months.

OBJECTIVES

Determine the current extent of clinically-controlled asthma and asthma-related quality-of-life among patients previously considered "severe-controlled".

METHODS

69 patients considered "severe-controlled" 4 years earlier answered a questionnaire that included the asthma control test (ACT), demographics, education, comorbidities, medications, asthma-related healthcare utilization, atopy history, environmental exposures, and follow-up. Patients underwent spirometry, eosinophil count, total IgE, and skin-prick testing for airborne allergens.

RESULTS

Ninety-seven percent reported using combined inhalers (ICS + LABA) regularly. Only 4% visited the ER and none was hospitalized in the last year. Average predicted FEV₁ was 80%. Average ACT score was 19; 51% reported recurrent heartburn, 46% night awakenings and 70% recurrent rhinitis. Skin-prick testing was positive in 72%, average IgE was 376 IU/ml. Eosinophil counts were ≥300/ml in 42% and ≥400/ml in 25%. ACT < 20 was strongly related to recurrent heartburn. Formal education was related to ACT ≥ 20 (p = 0.045) and perception of good asthma control the previous month (p < 0.001). Eosinophil count, recurrent heartburn, total IgE, and recurrent rhinitis were interrelated.

CONCLUSIONS

Among severe asthmatics, good drug compliance, low use of relievers and low rates of exacerbations do not necessarily reflect asthma-related quality-of-life and optimal control. We urge physicians and HMOs to address asthma control in terms of quality-of-life based on validated questionnaires, and offer all patients asthma education; perhaps more to those with low formal education.

The Relationship between Chemokine Ligand 3 and Allergic Rhinitis

Background Allergic rhinitis (AR) is a chronic and frequent condition characterized by an excessive response of the immune system to innocent substances encountered in the nasal mucosa. These reactions are mediated by many factors, including chemokines. Chemokine ligand 3 (CCL3, a macrophage inflammatory protein 1α) is a chemokine implicated in the activation of mast cells - white cells shown to be highly involved in orchestrating allergic reactions. The present study evaluated the role of CCL3 in AR. Material and methods Thirty-nine participants, including 24 patients with AR and 15 healthy controls, were evaluated for allergies to dust mites, cat and dog danders, cockroaches (Blatella germanica), molds, grasses, weeds, and tree pollen using skin prick tests. Participants were also evaluated for inflammatory conditions by measuring total blood count with differential; concentrations of rheumatoid factor, fibrinogen, and C-reactive protein; and erythrocyte sedimentation rate. CCL3 in blood samples was measured at the Immunology Laboratory, Cantacuzino National Institute for Military Medical Research and Development, Bucharest, Romania, using Human Multianalyte Profiling Base Kits (R&D Systems Inc., Minneapolis, MN). Results Mean serum CCL3 concentration was significantly higher in patients with AR than in controls (15.03 ± 7.11 pg/ml vs. 8.34 ± 4.46 pg/ml, p = 0.001 [t-test] and p = 0.026 [Mann-Whitney test]). CCL3 concentrations correlated with polysensitization, defined as two or more positive prick tests per patient (r = 0.325, p = 0.046) and seasonal AR (r = 0.482, p = 0.002). Conclusions Elevated levels of CCL3 were seen in our patients with AR. We have observed correlations with polysensitization and seasonal allergies. These results suggest that chemokines might play an important role in the pathogenesis of AR. In the future, chemokines might be used in endotype classification of patients with AR and as a possible target in the treatment of AR.

Pru p 9, a new allergen eliciting respiratory symptoms in subjects sensitized to peach tree pollen

Peach tree (PT) pollen sensitization is highly prevalent in subjects living in areas where this tree is widely cultivated. None of the allergens responsible for these sensitizations have been identified so far. Our aim was to identify the most relevant PT pollen allergens and analyze their capacity for inducing respiratory symptoms. We studied sixty-two individuals sensitized to PT pollen who developed symptoms after its exposure. The IgE binding profile on peach pollen extract by means of immunoblotting using sera from these subjects was analyzed. Protein extract was fractionated by anion-exchange chromatography and HPLC, fractions run in SDS-PAGE and proteins were identified from IgE-binding bands by mass spectrometry. Several allergenic proteins in the PT pollen extract were recognized by patients' IgE: a glucan endo-1,3-beta-glucosidase-like, a polygalacturonase, an UTP-glucose-1-phosphate uridylyltransferase and a PR-1a protein. This PR-1a protein is a novel allergen frequently recognized with a molecular mass of 18 kDa, named as Pru p 9 following the WHO-IUIS nomenclature. Skin Prick Test (SPT) performed with this allergen was positive in 41% of the PT pollen-sensitized clinical cases. Most of them had rhinitis or rhinoconjunctivitis, but a significant percentage experienced asthma with seasonal symptoms during the period of PT flowering. Nasal Provocation test (NPT) with Pru p 9 was positive in all cases with positive SPT to this new allergen eliciting nasal symptoms similar to those challenged with PT pollen. We demonstrate that PT pollen can induce sensitization and allergy in an exposed population, being Pru p 9 a relevant allergen responsible of respiratory symptoms. Considering the extensive peach worldwide production with a large number of people involved, our results add a great value for the diagnosis and management of subjects allergic to this pollen.

A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020

Precision allergy molecular diagnostic applications (PAMD@) is increasingly entering routine care. Currently, more than 130 allergenic molecules from more than 50 allergy sources are commercially available for in vitro specific immunoglobulin E (sIgE) testing. Since the last publication of this consensus document, a great deal of new information has become available regarding this topic, with over 100 publications in the last year alone. It thus seems quite reasonable to publish an update. It is imperative that clinicians and immunologists specifically trained in allergology keep abreast of the new and rapidly evolving evidence available for PAMD@.

PAMD@ may initially appear complex to interpret; however, with increasing experience, the information gained provides relevant information for the allergist. This is especially true for food allergy, Hymenoptera allergy, and for the selection of allergen immunotherapy. Nevertheless, all sIgE tests, including PAMD@, should be evaluated within the framework of a patient's clinical history, because allergen sensitization does not necessarily imply clinical relevant allergies.

The effect of medical treatment on nasal exhaled nitric oxide (NO) in patients with persistent allergic rhinitis: A randomized control study

PURPOSE

This study aimed to evaluate the role of nasal nitric oxide (NO) in the management of patients with persistent allergic rhinitis (PER).

METHODS

It was a randomized and comparative study. The study subjects were classified as controls (healthy subjects) or patients with PER based on defined criteria. All clinical, functional and biological data were collected for analyzing. Nasal fractional exhaled nitric oxide (FENO) was measured by electroluminescence device. Patients with PER were randomized for treatment with antihistamine (ATH) combined with leukotriene receptor antagonists (LRA) or only with intranasal steroids (INS).

RESULTS

During two years, 501 subjects were included: 234 control subjects and 267 patients with PER. The levels of nasal NO, total IgE, blood eosinophil counts, and apnea-hypopnea index (AHI) in patients with PER were higher than controls (P < 0.001; P < 0.05; P < 0.05; P < 0.01; respectively). There were statistically significant correlations between nasal NO, nasal peak flows, total IgE, and blood eosinophil counts in patients with PER (R = -0.687 and P = 0.0012; R = -0.643 and P = 0.0018; R = 0.432 and P = 0.0024; R = 0.445 and P = 0.002; respectively). After 6 months of treatment, patients treated with INS had greater improvement of clinical symptoms and reduction of nasal NO values than patients treated with ATH + LRA (985 ± 253 vs. 732 ± 298 ppb; P < 0.05).

CONCLUSION

Nasal NO measurement is a useful tool for the follow-up of patients with PER. It also helps clinicians to estimate the level of response to treatment in patients with PER.

[Diagnosis of allergy in asthma]

Allergy is a hypersensitivity reaction induced by immunological mechanisms. In asthma, allergy has a complex role and is usually IgE mediated. Allergy must be evaluated during the work up but evidence of IgE sensitivity does not mean that allergens play a role in the pathophysiology of the disease. The clinical relevance of the sensitivity has to be considered. This paper describes current available tools to screen for IgE sensitivity, allergen exposure and their role in asthma.

Nasal Provocation Test with Cat and Dog Extracts: Results according to Molecular Components

Background

IgE sensitization (atopy) to pets is commonly evaluated using pet dander extracts. However, the diagnosis by components seems to be more adequate to evaluate the clinical relevance (allergy) of sIgE sensitization.

Objective

To study the association between IgE sensitization to pet allergen components and clinical symptoms. Methodology. Dander extracts and sIgE levels to pet components (Can f 1, Can f 2, Can f 3, Can f 5, Fel d 1, Fel 2, and Fel 4) were measured in a rhinitis group (n = 101) and a control group (n = 101) and a control group (.

Results

Dog (34.6% vs. 23.5%) and cat dander (26.7% vs. 8.8%, p = 0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1, p = 0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1, p = 0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1.

Conclusions

Sensitization to pet dander extract identifies atopic patients, but its utility to predict clinical relevance is poor. Allergenic components could help to define the clinical relevance of sensitization to furry animals and could reduce the need for provocation test.

The presence of underlying asthma should be investigated in patients diagnosed with ACE inhibitor induced cough

INTRODUCTION

Why do only some of patients who are prescribed angiotensin converting enzyme inhibitors (ACE-I) develop cough? The pathogenesis of ACE-I-induced cough remains controversial and requires further studies.

OBJECTIVE

We aim to investigate whether asthma is a contributing cause of ACE-I-induced cough.

METHODS

Patients attending a cardiology clinic between March 2016 and March 2017 who were diagnosed with ACE-I induced cough were included in this study. ACE-I-induced cough was defined as cough which developed within 4 weeks after initiation of ACE-I therapy and which improved within 4 weeks after discontinuation of the ACE-I. Patients who had received ACE-I treatment for at least 6 months without side effects were included in the study as a control group. Face-to-face questionnaires, pulmonary function tests (PFT) and skin prick tests were applied to all the patients. If there was discordance between asthma history and PFT results, a methacholine bronchial provocation test (BPT) was performed.

RESULTS

A total of 43 patients with ACE-I induce cough were compared with 50 controls. Bronchial hyperreactivity (BHR), rhinitis, atopy and family history of asthma were more frequent in patients with ACE-I induced cough (P < .001). Patients with ACE-I-induced cough had significantly higher incidence of diagnosed asthma [OR = 8.28 (95%CI: 3.26-21.03) P < .001].

CONCLUSIONS

Asthma and an atopic background constitute a substantial risk factor for ACE-I induced cough. The presence of underlying asthma should be investigated in patients diagnosed with ACE inhibitor induced cough. However, the fact that most asthma patients tolerate ACE-I therapy, indicates that other cofactors are likely involved.

Assessment of Hymenoptera and Non-Hymenoptera Insect Bite and Sting Allergy Among Patients of Tropical Region of West Bengal, India

West Bengal, India, is inhabited by abundance and variety of insects that triggers sensitization in some humans to inhalant allergens and/or insect stings/venoms. Lack of research on this topic prevented accurate diagnosis and proper follow-up treatments to patients suffering from insect-induced allergies. The aim of our study was to identify the allergy-causing insects and evaluate resulting sensitization among a study population in West Bengal, India. The skin prick test (SPT) evaluated sensitivity of 450 patients who sought treatment at the Allergy and Asthma Research Center from July 2017 to June 2018. Eight insect allergens were tested: Common Black Ant (Lasius niger, Linnaeus 1758), Fire Ant (Solenopsis invicta, Buren 1972), Honey Bee (Apis cerana indica, Fabricius 1798), Common Wasp (Vespula vulgaris, Linnaeus 1758), Mosquito (Aedes aegypti, Linnaeus in Hasselquist 1762), American Cockroach (Periplaneta americana, Linnaeus 1758), House Fly (Musca domestica, Linnaeus 1758), and Grasshopper (Gesonula punctifrons, Stal 1861). From a total of 450 patients evaluated, 370 patients had positive SPT reaction from at least one of the 8 insect allergens tested. Sensitivity to some Hymenoptera insects (common black ant, 87.62%; fire ant, 84.59%; and honey bee, 67.02%) was found in higher proportion than non-Hymenoptera group (mosquito, 66.67%; American cockroach, 33.33%; house fly, 10.41%; and grasshopper, 5.14%). There was significant difference in sensitivity among child, adolescent, and adult (P < 0.001). While female patients showed more sensitivity than males to SPT, the difference was statistically insignificant. In regards to occupation, farmers and bee keepers were most sensitive of field workers sensitive to Hymenoptera-derived allergens.

Effect of Creatine Supplementation on the Airways of Youth Elite Soccer Players

Introduction

Owing to its well-established ergogenic potential, creatine is a highly popular food supplement in sports. As an oral supplement, creatine is considered safe and ethical. However, no data exist on the safety of creatine on lung function in athletes. The aim of this project was to evaluate the effects of a standard course of creatine on the airways of youth elite athletes.

Methods

Nineteen elite soccer players, 16–21 yr old, completed a stratified, randomized, double-blind, placebo-controlled, parallel-group trial. The creatine group (n = 9) ingested 0.3 g·kg⁻¹⋅d⁻¹ of creatine monohydrate (CM) for 1 wk (loading phase) and 5 g·d⁻¹ for 7 wk (maintenance phase), and the placebo group (n = 10) received the same dosages of maltodextrin. Airway inflammation (assessed by exhaled nitric oxide, F_ENO) and airway responsiveness (to dry air hyperpnoea) were measured pre- and postsupplementation.

Results

Mild, unfavorable changes in F_ENO were noticed by trend over the supplementation period in the CM group only (P = 0.056 for interaction, η² = 0.199), with a mean group change of 9 ± 13 ppb in the CM group versus −5 ± 16 ppb in the placebo group (P = 0.056, d = 0.695). Further, the maximum fall in forced expiratory volume in 1 s after dry air hyperpnoea was larger by trend postsupplementation in the CM group compared with the placebo group: 9.7% ± 7.5% vs 4.4% ± 1.4%, respectively (P = 0.070, d = 0.975). These adverse effects were more pronounced when atopic players only (n = 15) were considered.

Conclusion

On the basis of the observed trends and medium to large effect sizes, we cannot exclude that creatine supplementation has an adverse effect on the airways of elite athletes, particularly in those with allergic sensitization. Further safety profiling of the ergogenic food supplement is warranted.

Risk Factors and Comorbidities Associated With the Allergic Rhinitis Phenotype in Children According to the ARIA Classification

Purpose

Data are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study.

Methods

We enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed.

Results

The prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77–15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40–40.74).

Conclusions

Moderate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.

Lung function and bronchial hyper-reactivity from 11 to 18 years in children with bronchiolitis in infancy

BACKGROUND

Various trajectories for lung function and bronchial hyper-reactivity (BHR) from early childhood to adulthood are described, including puberty as a period with excessive lung growth. Bronchiolitis in infancy may be associated with increased risk of developing chronic obstructive pulmonary disease, but the development of respiratory patterns during puberty is poorly characterized for these children. We aimed to study the development and trajectories of lung function and BHR from 11 to 18 years of age in children hospitalized for bronchiolitis in infancy.

METHODS

Infants hospitalized for bronchiolitis at the University Hospitals in Stavanger and Bergen, Norway, during 1997-1998, and an age-matched control group, were included in a longitudinal follow-up study and examined at 11 and 18 years of age with spirometry and methacholine provocation test (MPT). The MPT data were managed as dose-response slope (DRS) in the statistical analyses. Changes in lung function and DRS from 11 to 18 years of age were analyzed by generalized estimating equations, including interaction terms.

RESULTS

z-scores for forced vital capacity (FVC), forced expiratory volume in first second (FEV₁ ), FEV₁ /FVC ratio, and DRS were not different from 11 to 18 years of age in both the post-bronchiolitis and the control group. The trajectories from 11 to 18 years did not differ between the two groups. BHR at age 11 was independently associated with asthma at age 18.

CONCLUSION

Children hospitalized for bronchiolitis had stable predicted lung function and BHR from 11 to 18 years of age. The lung function trajectories were not different from controls.

Aberrant Th2 Immune Responses Are Associated With a Reduced Frequency of IL-35-Induced Regulatory T Cells After Allergen Exposure in Patients With Allergic Asthma

PURPOSE

Allergen exposure induces aberrant T helper (Th) 2 immune responses in patients with allergic asthma, but not in sensitized asymptomatic and nonallergic subjects. Interleukin (IL)-35-induced regulatory T (iTr35) cells are a new subset of regulatory T cells with immunoregulatory properties. These cells can significantly suppress Th2 responses in seasonal allergic rhinitis. However, it remains unknown whether iTr35 cells are involved in the immunoregulation of allergic asthmatic individuals after specific allergen exposure.

METHODS

The iTr35 cell frequency in peripheral blood mononuclear cells (PBMCs) was measured in patients with allergic asthma as well as in asymptomatic and healthy subjects. The difference in naïve CD4⁺ T cell conversion to iTr35 cells in vitro during allergen stimulation was also investigated. The effects of iTr35 cells on naïve CD4⁺ T cell differentiation into Th2 cells, CD4⁺CD25^- T (Teff) cell proliferation and Th2 cytokine production in vitro were assessed.

RESULTS

Significantly reduced iTr35 cell frequencies and IL-35 expression levels were found in asthmatic patients with Derp1 allergy compared with asymptomatic and healthy subjects. Moreover, the circulating iTr35 cell proportion and IL-35 expression level in asthmatic patients gradually decreased with disease severity. Patients with allergic asthma had reduced transformation of naïve CD4⁺ T cells into iTr35 cells and IL-35 production after allergen exposure compared with asymptomatic and healthy subjects. Most importantly, iTr35 cells inhibited allergen-driven differentiation of naïve CD4⁺ T cells into Th2 cells, Teff cell proliferation and Th2 cytokine production in an IL-35-dependent manner.

CONCLUSIONS

The results of our study suggest that iTr35 cells may play an important role in preventing Th2 responses to allergens by secreting IL-35 and that iTr35 cells may be a potential new immune regulator of allergic asthma.

Association of the STAT6 rs3024974 (C/T) Polymorphism with IgE-Mediated Food Sensitization among West Bengal Population in India

INTRODUCTION

Genetic polymorphisms associated with IgE-mediated food sensitization have been a robust area of research for decades. A genome-wide search for susceptible loci regulating the IgE response (atopy) identified the candidate gene STAT6, which is important in the context of food allergic manifestations.

OBJECTIVE

The present study was designed to investigate the sensitization of West Bengal population against some common allergenic food items and to study the role of the STAT6 gene polymorphism in elevating food-specific IgE levels among sensitized individuals.

METHODS

Skin prick test was performed for 6 food items among 501 patients (126 children, 85 adolescents, and 290 adults)from West Bengal, India. Among them, 165 patients were selected for measurement of total IgE and food-specific IgE levels along with 165 controls. Finally, the STAT6 (rs3024974 (C/T) polymorphism was genotyped in 139 cases and control subjects.

RESULTS

Shrimp was identified as a dominant food allergen in adolescents and adults, whereas milk sensitization was highest in children. Food-sensitized patients with onset during childhood had significantly higher total IgE levels compared to patients with onset during adulthood (p < 0.00001). The frequency of the rs3024974 CC genotype in both cases and control subjects (55.40 and 46.76%, respectively) was higher than that of CT or TT. Patients with childhood onset bearing the CC genotype had significantly higher specific IgE levels in comparison to those with adult onset (p = 0.001).

CONCLUSION

Food sensitization has a genetic background and the rs3024974 polymorphism is associated with susceptibility and reaction severity in food-sensitized patients in West Bengal population in India.

Evaluation of Skin Prick-Test Reactions for Allergic Sensitization in Dogs With Clinical Symptoms Compatible With Atopic Dermatitis. A Pilot Study

Skin prick-test is the first choice for the detection of type I hypersensitivity in human atopic dermatitis. Canine atopic dermatitis resembles several symptoms of the disease in the human counterpart. In canine atopic dermatitis, intradermal testing is the test of choice, and there are few reports on the use of skin prick test (SPT) in dogs. The purpose of this study was to evaluate SPT reactions in atopic dogs and a healthy control group to 11 environmental allergens. Eleven glycerinated allergens were applied on the left lateral thorax of nine atopic dogs and nine healthy dogs. The skin was pricked with a feather lancet and evaluated for the positive percutaneous reaction at 5, 10, 15, and 20 min after the application of the allergens. Data were analyzed by the Shapiro-Wilk test to test for normal distribution. Data that did not meet normality were analyzed by a one-sided Wilcoxon ranked sum test with a p-value of 0.05. Six out of 9 atopic dogs tested positive for at least one of the allergens tested. None of the dogs in the control group showed a positive reaction to the allergens included in the test. Blomia tropicalis, Dermatophagoides farine, and Dermatophagoides pteronyssinus exhibited the highest reaction rate among the group of atopic dogs. There was not a statistical difference in the histamine reaction (positive control) between both groups. In this set of dogs, the test exhibited a 100% specificity and a sensitivity of 66%. The use of skin prick-test in the detection of causative allergens of human atopic dermatitis has proved to be a sensitive and specific tool frequently used by human allergists. Due to the number of similarities in canine and human atopic dermatitis, this could be a valuable tool that needs intensive research in veterinary medicine. The published research so far correlates to the results obtained in this investigation. However, future studies evaluating the concordance between in vitro specific IgE antibody assays and SPT must be carried out simultaneously to validate the test.

Allergic Rhinitis to Weed Pollen in Germany: Dominance by Plantain, Rising Prevalence, and Polysensitization Rates over 20 Years

BACKGROUND

In contrast to the 3 major aeroallergens tree pollen, grass pollen, and house dust mites, allergic rhinitis caused by herbal pollen has received comparatively little attention in recent clinical studies. Since various weeds flower during summer until fall, allergic rhinitis to weeds may be underdiagnosed and/or mistakenly diagnosed as grass pollen allergy.

OBJECTIVE

To investigate (i) the currently most frequent weed allergy between mugwort, ragweed, plantain, chamomile, nettle, and oilseed rape and (ii) time trends in prevalence of sensitization to weed pollen in the middle of Germany over the last 20 years.

METHODS

This study, the largest of its kind to date, monocentrically evaluated the prick test results of a total of 6,220 patients with suspected RCA over a period of 20 years (1998-2017).

RESULTS

In the study cohort, sensitization rates to plantain almost doubled from 26.6% in the decade 1998-2007 to 50.5% in 2008-2017. Identical increases were observed for ragweed, while sensitization rates for mugwort stayed largely unchanged. The most prominent increase in positive skin prick tests to plantain and ragweed pollen was mainly observed in younger patients. Further, we identified a trend toward polysensitization, currently dominated by plantain and ragweed. Sensitization to weed pollen was found to be highly associated with additional sensitizations to grass and/or birch pollen.

CONCLUSION

Plantain is currently the best choice to screen rhinitis patients for weed allergy which identifies 86% of all weed-sensitized individuals, at least in Germany. Over the last 20 years, we demonstrate a significant rise in the total number of weed pollen sensitization as well as increases in polysensitization, predominantly in younger patients.

Investigation of house dust mite induced allergy using logistic regression in West Bengal, India

BACKGROUND

The diagnosis of house dust mite (HDM) allergy based on Skin prick test (SPT) is not accurate, especially in lower risk cases. Our aim is to develop and validate a predictive model to diagnose the HDM allergic symptoms (urticaria, allergic rhinitis, asthma).

METHODS

A forward-step logistic regression model was developed using a data set of 537 patients of West Bengal, India consisting of clinical variables (SPT based on 6 allergens of house dust and house dust mites, total IgE) and demographic characteristics (age, sex, house conditions). The output probability was estimated from the allergic symptoms shown by the patients. We finally prospectively validated a data set of 600 patients.

RESULTS

The gradual inclusion of the variables increased the correlation between observed and predicted probabilities (correlation coefficient (r2) = 0.97). The model development using group-1 showed an accuracy rate of 99%, sensitivity and specificity of 99.7% and 88.6% respectively and the area under the receiver operating characteristics (ROC) curve (AUC) of 99%. The corresponding numbers for the validation of our model with group-2 were 87%, 95.6% and 66% and 86% respectively. The model predicted the probability of symptoms better than SPTs in combination (accuracy rate 0.76-0.80), especially in lower risk cases (probability< 0.8) that are highly difficult to diagnose.

CONCLUSION

This is perhaps the first attempt to model the outcome of HDM allergy in terms of symptoms, which could open up an alternative but highly efficient way for accurate diagnosis of HDM allergy enhancing the efficiency of immunotherapy.

Long-Term Therapy with Corticosteroids in Nasal Polyposis: A Bone Metabolism Assessment

Chronic rhinosinusitis associated with nasal polyposis (RSCwNP) affects 4% of the general population. As chronic condition, it requires chronic pharmacological treatment, whereas the surgical approach becomes necessary in obstructive and/or complicated cases. Intranasal and systemic corticosteroids (CS) represent the "Gold Standard" treatment for RSCwNP. The present study aimed to evaluate the side effects of prednisone in a group of patients with RSCwNP treated with long-term CS. In particular, attention was focused on bone disorders (osteopenia and osteoporosis) and prospective fracture risk increase. Forty patients (26 females, mean age 55.70 ± 14.03 years) affected by RSCwNP have been enrolled. Control group included 40 healthy subjects (17 females, mean age 56.37 ± 13.03 years). Nasal endoscopy, skin prick tests, nasal cytology, and bone densitometry were evaluated in all subjects. The likelihood of impaired bone metabolism (osteopenia or osteoporosis) was superimposable in both groups. Within RSCwNP group, no parameter was statistically significant in predicting a metabolism alteration.

Asthma and rhinitis in Greek furniture workers

Objective: The detection of asthma and rhinitis in furniture workers exposed to chemicals in the area of Thessaloniki Greece and the determination of the most useful tests for diagnosing the above occupational diseases.Methods: Eighty-three workers (76 men), 35 exposed to chemicals (CW), 23 to wood dust (WW), and 25 office workers (OW), serving as controls, filled in a specialized European Community Respiratory Health Survey (ECRHS) questionnaire for asthma and were submitted to clinical evaluation, spirometry, bronchodilation test, PEF computer algorithm OASYS-2, FeNO, skin prick tests (SPTs), rhinomanometry and methacholine inhalation challenge. Working conditions and protective measurements were also recorded. According to the results of all conducted tests, each subject was distributed to a subgroup: (a) normal, (b) asthma, (c) rhinitis, (d) asthma and rhinitis. Comparisons were performed among work groups.Results: The presence of asthma and/or rhinitis was higher among CW and WW compared to OW (p = 0.004). Significant differences among groups were observed in the questions «better weekend» (p < 0.034) and "improvement on vacation» (p < 0.000), in OASYS-2 Score (p < 0.000), in ABC Score (p < 0.000), and in methacholine score (p < 0.022). Rhinomanometry, FeNO, spirometry, and spirometry after bronchodilation had no significant differences among groups. Working conditions, ventilation system, work practice, use and type of mask revealed no significant differences.Conclusion: Asthma and rhinitis are significantly common among CW. Protective measurements used were not adequate to prevent asthma and or work related rhinitis. Early diagnosis might contribute to disease prevention and control.

Clinical Manifestations and Risk Factors of Anaphylaxis in Pollen-Food Allergy Syndrome

PURPOSE

Many studies have reported that pollen-food allergy syndrome (PFAS) can cause anaphylaxis. No comprehensive investigations into anaphylaxis in PFAS have been conducted, however. In this study, we investigated the clinical manifestations and risk factors for anaphylaxis in PFAS in Korean patients with pollinosis.

MATERIALS AND METHODS

Data were obtained from a nationwide cross-sectional study that previously reported on PFAS in Korean patients with pollinosis. Data from 273 patients with PFAS were collected, including demographics, list of culprit fruits and vegetables, and clinical manifestations of food allergy. We analyzed 27 anaphylaxis patients and compared them with patients with PFAS with oropharyngeal symptoms only (n=130).

RESULTS

The most common cause of anaphylaxis in PFAS was peanut (33.3%), apple (22.2%), walnut (22.2%), pine nut (18.5%), peach (14.8%), and ginseng (14.8%). Anaphylaxis was significantly associated with the strength of sensitization to alder, hazel, willow, poplar, timothy, and ragweed (p<0.05, respectively). Multivariable analysis revealed that the presence of atopic dermatitis [odds ratio (OR), 3.58; 95% confidence interval (CI), 1.25-10.23; p=0.017]; sensitization to hazel (OR, 5.27; 95% CI, 1.79-15.53; p=0.003), timothy (OR, 11.8; 95% CI, 2.70-51.64; p=0.001), or ragweed (OR, 3.18; 95% CI, 1.03-9.87; p=0.045); and the number of culprit foods (OR, 1.25; 95% CI, 1.15-1.37; p<0.001) were related to the development of anaphylaxis in PFAS.

CONCLUSION

The most common culprit foods causing anaphylaxis in PFAS were peanut and apple. The presence of atopic dermatitis; sensitization to hazel, timothy, or ragweed; and a greater number of culprit foods were risk factors for anaphylaxis in PFAS.

Olfactory dysfunction in patients with chronic rhinosinusitis with nasal polyps is associated with clinical-cytological grading severity

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common inflammatory disorder, affecting about 4% of the worldwide population and strongly impacting the quality of life. CRSwNP is still a challenge for ENT specialists in terms of its unknown pathogenesis, difficulty in management and frequent relapse. Olfactory impairment frequently affects CRSwNP patients. We tested the hypothesis that clinical-cytological grading (CCG) could be associated with olfactory dysfunction. The study was cross-sectional, enrolling 62 patients (37 males, 25 females, mean age 49 years, range 18-83) suffering from newly diagnosed CRSwNP. Olfactory dysfunction was very frequent (about 90%) and did not depend on nasal obstruction as assessed by both polyp size and nasal airflow limitation. A CCG > 4 was the best cut-off value to suspect olfactory dysfunction [area under the ROC curve of 0.831 (0.715 to 0.914)]; in addition, the statistical risk of having dysosmia was over 7-fold higher in subjects with CCG > 4 compared with subjects reporting a CCG < 4 (adjOR 7.46). The present study underlines that olfactory dysfunction is common in CRSwNP patients and demonstrates an association between olfactory dysfunction and inflammation, suggesting that CCG could be useful in the work-up of CRSwNP patients and in suspecting olfactory impairment.

Allergens in dog extracts: Implication for diagnosis and treatment

BACKGROUND

Five to ten percent of the population in affluent countries are allergic to dog. Diagnosis and treatment is based on allergen extracts from natural sources where composition and concentration are poorly defined.

OBJECTIVE

We aimed to quantify six dog allergens (Can f 1-6) in commercial skin prick test (SPT) solutions and to determine individual allergen profiles in dogs.

METHOD

The allergen content of SPT solutions from five vendors and allergen source material from three anatomical sites were analyzed. Fur and saliva samples were collected from a mixed population of 120 dogs. Can f 1-6 were quantified by inhibition ELISA using purified recombinant or natural allergens and polyclonal or monoclonal antibodies. Allergenicity was analyzed by basophil activation test.

RESULTS

Extensive variation in allergen composition was observed in commercial SPT vials resulting in a patient-dependent ability to activate basophils. Extract heterogeneity depended on collection site and allergen composition in individual dogs and source materials. Can f 2 and Can f 6 exhibited low levels in fur and SPT solutions, whereas Can f 4, which was the dominating allergen in fur samples, did not display similar high proportions in SPT solutions. Can f 3 varied most among SPT solutions.

CONCLUSION

There is a great variation of dog allergens in natural extracts raising questions of source, sampling, processing and ultimately of standardization and minimum allergen levels for accurate diagnosis and treatment.

Severe asthma: Comparison of different classifications of severity and control

BACKGROUND

Criteria of asthma severity and control lack standardization.

OBJECTIVE

to compare classifications of asthma severity and control, applied to patients from a severe asthma clinic.

METHODS

Cross-sectional study of 473 patients followed up for ≥6 months, reclassified using three criteria: 1) the World Health Organization (WHO) 2010, 2) the American Thoracic Society (ATS) 2000, and 3) the European Respiratory Society (ERS)/ATS 2014. In order to evaluate disease control, the 2012 and 2014 Global Initiative for Asthma (GINA) classifications were compared.

RESULTS

According to the definition of WHO 2010, 429 had Difficult-to-treat severe asthma and only 12 presented Treatment-resistant severe asthma. 114 patients had Refractory asthma by ATS 2000 and 88 had Severe asthma by ERS/ATS 2014. Considering the definitions of WHO 2010, only 9 out of 12 with Treatment-resistant and 64 out of 429 with Difficult-to-treat severe asthma met the criteria of ATS 2000 and ERS/ATS 2014. As for GINA classification of control, 208 (44%) of the 473 subjects were classified as having asthma controlled by the 2014 criteria, whereas only 45 (10%) patients had controlled asthma by the GINA 2012 criteria. The Kappa statistic indicates the highest agreement of the severity classification occurred between the criteria of ATS 2000 and ERS/ATS 2014 (0.64).

CONCLUSION

Good agreement was found between Refractory asthma ATS 2000 and Severe asthma ERS/ATS 2014 classifications. However, poor agreement was observed between the severity rating proposed by the WHO and other classifications. The GINA control classifications of 2012 and 2014 also agreed poorly.

The role of atopy in the pathogenesis of bleomycin pulmonary toxicity

INTRODUCTION

Bleomycin pulmonary toxicity (BPT) is a potentially life-threatening consequence of bleomycin usage in patients. An overproduction of epithelium-derived cytokines, habitually linked to allergic inflammation, has been recently revealed in experimental models of BPT.

METHODS

We assessed retrospectively our cohort of patients with Hodgkin Lymphoma treated with bleomycin between 2014 and 2016 for their demographic, clinical features, including BPT development, atopy status and risk factors for BPT. Then they were invited for allergy testing and blood sample collection. The samples were stimulated with different stimuli (Bleomycin, IL-33, TSLP) for 24 h on cell culture. The culture supernatants were analysed for TGF-β, Galectin3, Arginin, Amphiregulin, Eotaxin, IFNγ, TNFα, IL1β, 4, 5, 6, 10, 13, 17, MIP-1α, and bleomycin hydrolase (BLH) levels.

RESULTS

The cohort consisted of 51 patients showed that atopy was the only significant risk factor for BPT occurrence (OR: 7.2, p = 0.007). Fourteen subjects were included for blood analysis. The analysis of supernatants at the unstimulated condition revealed that BLH and Amphiregulin were significantly lower in patients who had BPT than controls. The BLH cut-off that best identified a history of BPT was 175.31 (Sensitivity: 62.5%, specificity: 100%). Following the stimulation, BLH reduced compared to the unstimulated condition and the difference between groups remained significant (p < 0.05).

CONCLUSION

Our study is the first to report that low levels of bleomycin hydrolase in allergic individuals may be predisposing to a possible pathway of fibrosis.

Early molecular biomarkers predicting the evolution of allergic rhinitis and its comorbidities: A longitudinal multicenter study of a patient cohort

BACKGROUND

Pollen-related seasonal allergic rhinoconjunctivitis (SAR) is a very frequent pediatric disease in Westernized countries. Risk factors and disease phenotypes have been thoroughly examined in several cross-sectional studies. By contrast, only a few studies have examined disease evolution in patient cohorts. We investigated predictive biomarkers of disease evolution in a large cohort of children with SAR.

METHODS

During 2015-2017 (follow-up), we re-examined 401 patients from those enrolled in 2009-2011 (baseline) by the "Panallergens in Pediatrics" study, a large multicenter survey of Italian children with SAR. Information on clinical history (standard questionnaire, AllergyCARD®; TPS, Italy) and skin prick tests for inhalant and foods extracts (ALK-Abelló, Hørsholm, Denmark) was acquired as at baseline visit. Evolution in clinical and sensitization data of patients was analyzed over time, as well as their association with the main baseline characteristics and atopy risk factors.

RESULTS

The average age of participants was 10.4 ± 3.4 years at baseline and 16.2 ± 3.6 years at follow-up. SAR persisted in 93.3% of patients at follow-up and became more frequently associated with asthma (from 36.7% at baseline to 48.6% at follow-up) and oral allergy syndrome (OAS, from 23.4% to 37.7%). Compared to baseline, the prevalence of skin sensitization to some pollens (Phleum pratense, Corylus avellana, Platanus acerifolia, Artemisia vulgaris) and vegetables (hazelnut, wheat, and apple) significantly decreased at follow-up. Earlier onset of SAR and polysensitization at baseline were associated with incident asthma at follow-up. The presence at baseline of serum IgE to the following allergen molecules was identified as biomarkers of clinical evolution: (a) Phl p 1, for persistence of SAR; (b) Phl p 5, for persistence of both rhinitis and asthma; (c) Pru p 3, for new onset of asthma; (d) Bet v 1, for persistence of OAS.

CONCLUSIONS

Seasonal allergic rhinoconjunctivitis is clinically heterogeneous in its evolution from childhood to adolescence. The detection of serum IgE to specific molecules (Phl p 1, Phl p 5, Bet v 1, Pru p 3) may be useful as biomarkers to predict SAR persistence and future onset of comorbidities, such as asthma and/or OAS.

The Association between Asthma and Obesity in Children - Inflammatory and Mechanical Factors

BACKGROUND:

Association of asthma and obesity has been demonstrated in numerous epidemiological studies. However, the underlying mechanisms of the association are not well understood. Both conditions are characterised by chronic tissue inflammation, which includes numerous different inflammatory markers, and possible atopy.

AIM:

The study aimed to investigate the association between asthma and obesity in children and assess several of potential underlying mechanisms, including the parameters of systemic inflammation (CRP, fibrinogen) and the mechanical effect of obesity on the respiratory system through parameters of lung function. An additional aim was to examine the role of atopy in overweight children with asthma and to investigate the type of respiratory inflammation.

MATERIAL AND METHODS:

This prospective study included 72 patients in the age group of 7-15 years, including 38 with high body mass index (BMI), 16 with asthma and normal BMI, and 18 with asthma and high BMI for sex and age. Non-specific inflammatory markers (fibrinogen, CRP), eosinophilia, and total serum IgE were investigated. The patients underwent a skin prick test (SPT) with standard inhalant allergen extracts, measurement of fractional exhaled nitric oxide Fe (NO), and an assessment of lung function.

RESULTS:

In overweight groups of children we determined significantly higher values (p < 0.001) of both acute inflammatory reactants, CRP and fibrinogen, with no difference between children with and without asthma. There was a significant increase in eosinophilia, total IgE, and positive SPT in the asthmatic groups compared to the group of non-asthmatic patients (p < 0.001 for the three parameters). Compared to the group composed of overweight patients without asthma, the asthmatic patients had higher NO values (p < 0.001). No significant difference in the lung function parameters was found between the three groups (p > 0.05).

CONCLUSION:

A positive association between asthma and obesity with inflammation as an underlying mechanism, eosinophilic one in asthmatic patients and non-eosinophilic one in overweight patients, was determined. It seems that the lung function parameters did not differ between asthmatic patients and overweight patients. No influence of atopy in the association between asthma and obesity was verified. Further analyses of specific inflammatory markers, for an in-depth evaluation of the mechanisms leading to the association of obesity and asthma, are warranted.

Prevalence of atopy and allergic rhinitis in patients with adult non-cystic fibrosis bronchiectasis

Background/aim

Non-cystic fibrosis bronchiectasis (non-CF BR) is common in developing countries.Limited data are available regarding the impact of atopy, and no data are available regarding allergic rhinitis in patients with adult bronchiectasis.The aim of this study was to evaluate the prevalence of atopy and allergic rhinitis in the clinical conditions of patients with BR.

Materials and methods

The study enrolled 101 patients who were diagnosed with non-CF BR using high-resolution computed chest tomography. Allergic rhinitis (AR) was defined by skin prick test (SPT) positivity and the presence of any nasal symptoms (watery runny nose, nasal obstruction, nasal itching, and sneezing).

Results

The mean age of patients was 48 ± 15 years (range 18–82); 55 (54.5%) patients were female. SPT positivity was detected in 37 (36.6%) cases. AR was detected in 32 (31.7%) patients with non-CF BR. AR was related to dyspnea (P = 0.04) and number of admissions to an emergency department in the previous year (P = 0.01). Forced expiratory volume in 1 s and forced vital capacity in patients with and without AR were different (P = 0.01 and P = 0.01, respectively). AR was correlated with number of admissions to an emergency department in the last year (r = 0.417, P = 0.005).

Conclusion

We concluded that atopy was detected in more than one-third of adult non-CF BR patients. This study demonstrated that non-CF BR patients might have AR; it might be important to be aware of nasal symptoms in non-CF BR patients.

Sensitisation to airborne allergens as a risk factor for allergic rhinitis and asthma in the Polish population

Introduction

The patterns of sensitisation to airborne allergens and their association with allergic diseases have been analysed in different geographical regions.

Aim

To analyse the impact of sensitisation to airborne allergens on allergic rhinitis (AR) and asthma in different age groups of the Polish population.

Material and methods

Completed questionnaires of 18,617 subjects (53.8% females), collected within the ECAP, a cross-sectional multicentre study, were analysed. Three groups of respondents were included: 6-7-year-olds (24.2%), 13-14-year-olds (25.4%), 20-44-year-olds (50.4%). The clinical part (an anamnesis, physical examination, spirometry, skin prick tests and an assay of major airborne allergen-specific IgE) was attended by 25.7% of the respondents.

Results

The AR was most strongly related to sensitisation to Dermatophagoides pteronyssinus, with the highest odds ratios of 10 in two younger groups and of 16 for persistent AR in children. It was also the most important risk factor for allergic asthma, with odd ratios from 8.34 in children to 6.40 in adolescents. Sensitisation to grass pollen allergens was a major risk factor for both AR, with odds ratios from 9.16 in adults to 7.87 in adolescents, and asthma, with odds ratios from 6.16 in adolescents to 5.67 in adults.

Conclusions

AR and asthma shared common risk factors, independently of age. Sensitisation to airborne allergens was significantly associated with asthma and, even more strongly, with AR, across all age groups. The AR was the strongest risk factor for allergic asthma in the youngest group. Persistent AR increased asthma risk more than intermittent AR in all age groups.

Storage mite concentrations are underestimated compared to house dust mite concentrations

Dwellings are increasingly well insulated to save energy and this leads to higher humidity and temperature, which improves conditions for mites. Dermatophagoides antigens are the main allergens involved and tested in atopic asthma. We developed three new species-specific quantitative PCR (qPCR) methods for house dust mites (Dermatophagoides pteronyssinus and D. farinae) and storages mites (Acarus siro, Glycyphagus domesticus, Lepidoglyphus destructor). We sampled dust with electrostatic dust collectors, in the bedrooms, under beds and in the kitchens of patients with allergies (n = 24) and healthy controls (n = 18). Mite quantification was carried out with the three new qPCRs and the qPCR previously described for the Dermatophagoides genus. The qPCRs were highly specific and efficient for house dust mite species and the storage mites. Storage mite concentrations were higher than house dust mite concentrations and were higher in dwellings of patients with allergies. Consequently, allergists should test more often patients against the storage mite antigens by prick tests or IgE serology. Dampness is a major factor in storage mite development and the presence of effective mechanical ventilation can reduce storage mite concentrations four-fold. In addition, to limit exposure to dust mites, treatments should be used throughout dwellings and not only in patients' bedrooms.

Disentangling the heterogeneity of allergic respiratory diseases by latent class analysis reveals novel phenotypes

BACKGROUND

Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached.

AIM

To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis.

METHODS

Seven hundred and twenty-eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA-classes.

RESULTS

A six-class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non-allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA-classes.

CONCLUSION

Novel severe phenotypes of participants with co-occurrence of ocular, nasal and bronchial symptoms, and exacerbation-prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.

The Prevalence of Allergic Rhinitis toAmbrosia Elatior in OlteniaArea and the Association with Allergic Conjunctivitis or Asthma

Introduction-Ambrosia elatior pollen sensitivity can lead to respiratory diseases such as rhinitis, asthma and allergic conjunctivitis. Ambrosia is quite an important source of pollen and it is thought to be an invasive plant. Sensitivity prevalence to Ambrosia pollen varies from one country to another. The aim of the present study was to assess the prevalence of pollen allergic rhinitis caused by Ambrosia elatior in the Oltenia area located in the south west part of Romania. Material and method - The study was carried on 1004 patients with allergic rhinitis. All the patients experienced symptoms of allergic rhinitis, associated with /without conjunctivitis or asthma, and positive skin tests to aeroallergens. Results - In the group under study, 48,80% of the cases are sensitized to Ambrosia elatior pollen. The number of patients with allergic rhinitis and pollen sensitivity to Ambrosia is higher in 2014-2015 compared to 2012, i.e. 282 cases and the symptoms are moderate-severe. Conclusions - Ambrosia elatior pollen has become a major source of aeroallergen in Oltenia area.

Screening instrument to identify skin prick test-negative patients with asthma and/or rhinitis

INTRODUCTION

To the best of our knowledge, there is no prediction tool for determining respiratory allergy in patients with asthma and/or rhinitis.

OBJECTIVES

As such, this study aimed to develop an instrument for identifying skin prick test (SPT)-negative patients with asthma and/or rhinitis.

METHODS

This cross-sectional study screened 510 consecutive patients diagnosed with asthma and/or rhinitis between November 2009 and May 2011 in Ankara, Turkey. A structured questionnaire was the screening tool that was administered during the initial visit by the treating specialist and compared with a SPT result. All 15 variables were analysed using the logistic regression model to obtain β values (a score) for each variable. Each variable had a score, and scores were summed up to obtain final score for each patient.

RESULTS

The study included 363 patients, of which 165 (45.5%) were SPT positive. The final model included 13 variables. The lowest and highest scores were -21 and 26. A total score of 5.5 had sensitivity of 63% and specificity of 80%. The area under the receiver operating characteristic curve was 0.78. The histogram of the total scores for the study population was bimodal.

CONCLUSIONS

We designed a highly specific 13-item instrument for identifying SPT-negative patients. It may be used in middle income countries where allergy testing is expensive, not reimbursed or few allergy clinics are available. We think that our idea is interesting, that needs further research.

Severe uncontrolled asthma with bronchiectasis: a pilot study of an emerging phenotype that responds to mepolizumab

Background

Asthma and bronchiectasis are different conditions that frequently coexist. The prevalence of bronchiectasis rises considerably in subjects with severe asthma (25%–51%).

Objective

We evaluated the clinical and biological efficacy of mepolizumab on our pilot population of severe uncontrolled asthmatics with bronchiectasis not related to other pathologies.

Patients and methods

Four patients with severe uncontrolled asthma and diagnosed as bronchiectasis were recruited and started biological treatment with mepolizumab. Standard investigations were performed in all four patients at baseline (T0), after 3 months (T1) and after 1 year (T2) of treatment.

Results

After 1 year (T2) of therapy with mepolizumab, patients showed a significant increment of asthma control test value (12±1.1 vs 24.5±0.3, P<0.01), a reduction of the number of exacerbations/year (5±0.7 vs 0.75±0.75, P<0.01), an increase of pre-bronchodilator FEV₁ (1,680±500 vs 1,860±550 mL, P<0.01) and a reduction of eosinophils in blood (0.75±0.14 vs 0.12±0.02 cells/µL, P<0.01), in the sputum (9.6%±2.1% vs 5.6%±2.7%, P<0.05) and in nasal cytology (++ vs +).

Conclusion

The efficacy of mepolizumab in terms of reduction of inflammation and increase of control that we observed in our patients might suggest that targeting the IL-5 in severe eosinophilic asthma with bronchiectasis may be a good therapeutic strategy.

Home environment and diseases in early life are associated with allergic rhinitis

OBJECTIVE

Risk factors in relation to allergic rhinitis (AR) remain unclear despite considerable interest. This study aimed to analysis the relationship between home environment and diseases in early life and AR.

METHODS

In a case-control survey, 242 AR patients and 258 healthy persons responded to questionnaires designed to capture pre-pregnancy/pregnancy diseases, maternal medication usage, diseases in early life of participants, family allergic history and home environmental factors. Forty risk factors potentially connected with AR were investigated and analyzed with chi-square test and logistic regression.

RESULTS

There was no correlation between mother's disorders such as periodontitis, chronic rhinitis, diabetes etc. and AR (p > 0.05). A logistic regression analysis showed that neonatal jaundice (p < 0.001), respiratory system infection (p < 0.001), diarrhea (p < 0.01), eczema (p < 0.01) in the early life and home environmental factors such as house decoration (p < 0.01), mold environment (p < 0.001), keeping flowers and plants (p < 0.001), passive smoking (p < 0.01) were associated with AR.

CONCLUSION

Diseases in early life and home environment are closely associated with AR.

Evaluation of major mite allergens from European standardized commercial extracts for in vivo diagnosis: addressing the need for precision medicine

Background

Skin prick testing is the first-line interventional method to diagnose IgE mediated allergic diseases. Methodological differences in manufacturing processes and extract standardization may lead to variations in the reagent quality and potency. The current study evaluates sixteen commercially available Dermatophagoides pteronyssinus and Blomia tropicalis extracts for allergy diagnosis from different European manufacturers regarding allergen composition and content and whether these differences could influence their biological activity.

Methods

Mite-allergic subjects (n = 21) were skin-tested with the extracts and studied for immunoglobulin E reactivity. Nine extracts from D. pteronyssinus and seven from B. tropicalis were analysed for total protein content by Bradford and ELISA double sandwich was used to quantify specific antibodies for D. pteronyssinus and B. tropicalis major allergens from nine different manufacturers.

Results

Mite extracts showed a 10–60 fold variation regarding the total protein content. The contents of the major allergens of D. pteronyssinus and B. tropicalis differed considerably (30–53 fold change) among the extracts. Blo t 5 was quantitatively present in < 50% of the of the B. tropicalis reagents and could not be clearly detected by immunoblotting in the majority of the B. tropicalis commercial extracts.

Conclusions

Certain natural D. pteronyssinus and B. tropicalis extracts lack important allergens showing a considerable variability in composition and content. A closer collaboration among clinicians, allergen manufacturing companies and regulatory agencies to improve the quality and consistency of D. pteronyssinus and B. tropicalis extracts is warranted to achieve a more precise diagnosis and treatment of house dust mite allergy.

Evaluation of Sensitivity Toward Storage Mites and House Dust Mites Among Nasobronchial Allergic Patients of Kolkata, India

House dust mites (HDMs) are the major constituents of house dust (HD). HD and HDM sensitization is well documented worldwide. Storage mite (SM) sensitization is presently lacking from India. The present study evaluated the sensitization of both HDM and SM among 372 allergic rhinitis patients reported to the Allergy and Asthma Research Center of Kolkata metropolitan, India. HD samples were collected from the patients' home and analyzed for the major constituent mites. HD and six constituent mites Dermatophagoides pteronyssinus (DP), Dermatophagoides farina Hughes (Acari: Pyroglyphidae) (DF), Blomia tropicalis (BT), Acarus siro Linnaeus (Acari: Acaridae) (AS), Lepidoglyphus destructor (LD), and Tyrophagus putrescentiae (Schrank) (Acari: Acaridae) (TP) are tested for the allergenic potential through Skin Prick Test (SPT). Three SMs, namely AS, LD, and TP, were newly included in the mite SPT extract for the first time in Kolkata. In total, 330 patients showed significant positive SPT toward any one allergen tested. HD was the major elicitor exhibiting 92.42% response. Individuals of age group 15-40 were the worst sufferers. DF showed the highest sensitization (87.87%) among the dust mites. The SMs also contributed significantly to prove their sensitizing potential. SPT rates for AS, LD, and TP were 33, 25, and 18%, respectively. SPT grades and total Immunoglobulin E (IgE) were positively correlated for each of the allergens. Most of the patients were multi-sensitized (95%) and represented markedly high total IgE levels (>500 IU/ml). Three SMs proved to be significant allergens for the studied population. The sensitization toward these SMs is first time reported from India and can be recommended for inclusion of routine SPT for better outcome in the future.

Sensitivity and specificity of standardised allergen extracts in skin prick test for diagnoses of IgE-mediated respiratory allergies

Background

Skin prick tests (SPTs) are essential for the diagnosis of IgE-mediated allergy and are influenced by extract quality, biological potency and concentration of allergen.

Methods

In this open multicentre study 431 patients, aged 18-64 years were enrolled. Patients had a history of IgE-mediated allergy and a sensitisation (previous positive SPT of any manufacturer) against at least one of the investigated allergens: 6-grass pollen, house dust mite, birch and mugwort pollen. In our study, these allergens were tested in five concentrations each. To establish the optimal trade-off between sensitivity and specificity, the area under the receiver operating characteristic (ROC) curve was estimated by comparing the outcome of the SPT with three methods referred to as 'reference methods' (specific IgE, clinical case history and a previous SPT).

Results

For all allergens and reference methods, the area under the ROC curves were highly significant (p < 0.001). Specific IgE reference method resulted in the largest area under the curve (AUC) for all allergens (0.80-0.90) followed by previous SPT (0.70-0.87) and case history (0.65-0.74). Sensitivity of SPT increased with increasing concentration and specificity decreased. For all allergens, compared to specific IgE, the highest sensitivity (specificity at least 80%) was observed for the SPT solution of 50,000 Standardised Units (SU)/mL (grass pollen, birch pollen, house dust mite and mugwort).

Conclusion

In this study, with a large number of patients, it was demonstrated that clinical case history, previous SPT and specific IgE measurement could all be used as reference methods for the assessment of sensitivity/specificity of SPT solutions. The comparison of SPT with specific IgE resulted in the largest AUC. The highest sensitivity was observed for the SPT solution of 50,000 SU/mL.Trial registration EudraCT: 2006-005304-14.

Dissociating polysensitization and multimorbidity in children and adults from a Polish general population cohort

Background

Links between multimorbidity of allergic diseases and allergen sensitization are still under debate, especially in adults. This study aimed to establish a relationship between polysensitization and allergic multimorbidity in children and adults and the allergens involved in multimorbidity.

Material and method

A cross-sectional multicentre study enrolled children aged 6-7 and 13-14 years and adults aged 20-44 years from a Polish national cohort. The diagnosis of allergic diseases was made by a physician. Skin prick tests to 13 allergens and serum IgE levels to 4 allergens were tested.

Results

Among the 3856 participants, single disease (asthma, allergic rhinitis or atopic dermatitis) was diagnosed in 27.7% subjects and allergic multimorbidity in 9.3%. Allergic multimorbidity occurred more commonly in children than in adults (p < 0.01). Asthma or atopic dermatitis alone were not associated with polysensitization. Rhinitis and multimorbidity were associated with polysensitization. Allergic multimorbidity occurred in 2.2% of participants with negative skin prick tests, 9.8% of those with one positive prick test (SPT ≥ 3 mm) and 20.6% of polysensitized ones (p < 0.001). There was an increasing risk of multimorbidity depending on the number of positive prick tests for both SPT ≥ 3 mm (OR 9.6-16.5) and SPT ≥ 6 mm (OR 5.9-13.7). A statistically significant relationship was found between allergic multimorbidity and sensitization to cat and mite allergens.

Conclusions

Multimorbidity is associated with polysensitization especially in children compared with adults in Polish population cohort. New insights into single disease patterns were found: bronchial asthma is the strongest risk factor for the development of multimorbidity in comparison with allergic rhinitis and atopic dermatitis.

Obesity and asthma: clinical and laboratory characterization of a common combination

OBJECTIVE

To evaluate the relationship between obesity and asthma.

METHODS

This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires.

RESULTS

Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02).

CONCLUSIONS

Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.

Detection of genuine grass pollen sensitization in children by skin testing with a recombinant grass pollen hybrid

BACKGROUND

Skin testing represents a commonly used first diagnostic method in clinical practice, but allergen extracts may vary in composition and often contain cross-reactive allergens and therefore do not always allow the precise identification of the sensitizing allergen source. Our aim was to investigate the suitability of a single recombinant hybrid molecule, consisting of the four major timothy grass pollen allergens (Phl p 1, Phl p 2, Phl p 5, and Phl p 6) for in vivo diagnosis of genuine grass pollen allergy in children suffering from pollinosis.

METHODS

Sixty-four children aged from 6 to 17 years with a positive skin reaction and/or specific IgE to grass pollen extract and respiratory symptoms of pollinosis as well as 9 control children with allergy to other allergen sources were studied. SPT was performed with the recombinant hybrid, the four recombinant timothy grass pollen allergens, and grass pollen extract. Specific IgE reactivity to 176 micro-arrayed allergen molecules was determined using ImmunoCAP ISAC technology. IgE reactivity to the hybrid was detected by non-denaturing RAST-based dot blot assay.

RESULTS

Genuine grass pollen sensitization was confirmed in 94% of the children with positive SPT to grass pollen extract by SPT and IgE reactivity to the hybrid. The four hybrid-negative children showed IgE reactivity to cross-reactive allergens such as Phl p 4, Phl p 11, and Phl p 12 and had also sensitizations to pollen allergens from unrelated plants.

CONCLUSIONS

The recombinant hybrid molecule represents a useful tool for in vivo diagnosis of genuine grass pollen sensitization.