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Yan T, Song X, Ding X, Liu X, Lan T, Chen T, Wang M, Wang M. Exposure to household dust, allergens, and endotoxin and allergy-related outcomes alternation in the general U.S. population. ENVIRONMENTAL RESEARCH 2023; 226:115713. [PMID: 36934863 DOI: 10.1016/j.envres.2023.115713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 06/18/2023]
Abstract
It has been widely reported that the general population was at an increased risk of allergy diseases, which probably be related with household allergens exposure. However, the difference of local and systemic allergic reactions exposure to allergens has not been reported in the general population previously. The data of 1094 U.S. adults from the National Health and Nutrition Examination Survey (NHANES) 2005-2006 data bank were analyzed. Dust, allergens (Bia g 1, Bia g 2, Can f 1, Feld 1, Derp 1, Mus m 1, Rat n 1, Alternaria alternate, and Aspergillus fumigatus), and endotoxin, were measured to estimate sensitizing source exposure. And allergy-related outcomes indicators including hay fever, sneezing, allergic rhinitis (AR), immunoglobulin E (IgE), and allergic sensitization, were evaluzted to estimate local and systemic allergic reactions. Multiple linear regression and logistic regression models were used to examine the associations of sensitizer and allergy-related outcomes. The mean or median concentration of dust and endotoxin were 0.66 g and 12.98 EU/mg dust. The Derp 1, Mus m 1, Rat n 1, Alternaria alternate, and Aspergillus fumigatus were the main allergens in the dust, with the concentrations of 30.66 ng/g dust, 30.73 ng/g dust, 5.94 ng/g dust, 5.20 ng/g dust, and 207.68 μg/g dust, respectively. The prevalence of AR was 34.2% among the general population. After controlling for sociodemographic factors, we found that the allergens, such as Can f 1 and Feld 1, were positively associated with AR. The prevalence of allergic sensitization was about 20%. Dust and endotoxin were found positively associated with allergic sensitization, while Bia g 2, Rat n 1, Alternaria alternate, and Aspergillus fumigatus were inversely associated with that. Dust and endotoxin probably be associated with higher risk of local allergic reactions, while some allergens, such as Bia g 2, Rat n 1, Alternaria alternate, and Aspergillus fumigatus probably be associated with lower risk of systemic allergic reactions.
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Affiliation(s)
- Tenglong Yan
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing, 100093, China
| | - Xin Song
- School of Public Health and the Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Xiaowen Ding
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing, 100093, China
| | - Xiaodong Liu
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing, 100093, China
| | - Tian Lan
- Beijing Institute of Occupational Disease Prevention and Treatment, Beijing, 100093, China
| | - Tian Chen
- School of Public Health and the Beijing Key Laboratory of Environmental Toxicology, Capital Medical University, Beijing, 100069, China
| | - Minghui Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China.
| | - Mengyang Wang
- Department of Neurology, Sanbo Brain Hospital, Capital Medical University, Beijing, 100093, China.
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Lin J, Chen D, Guan L, Chang K, Li D, Sun B, Yang P, Liu Z. House dust mite exposure enhances immune responses to ovalbumin-induced intestinal allergy. Sci Rep 2022; 12:5216. [PMID: 35338219 PMCID: PMC8956666 DOI: 10.1038/s41598-022-09196-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
House dust mites (HDM) are one of the important factors of airway allergic diseases, HDM allergens can be detected in the human gut mucosa, which induces local inflammation and increases intestinal epithelial permeability. This study tests a hypothesis that HDM contribute to the development of OVA (ovalbumin)-induced intestinal allergy. The serum levels of IgE against HDM in patients with food allergy were detected with UniCAP100 (Pharmacia, Uppsala, Sweden); a mouse model of food allergy was developed with OVA and HDM as the specific antigens. Compared to healthy controls, patients with food allergy have higher levels of serum HDM-specific IgE. Compared to food allergy alone groups, the levels of HDM-specific IgE in patients with food allergy and asthma or allergic rhinitis were significantly higher. In mouse models, we found that HDM/OVA induced allergy-like symptoms, lower body temperature, and lower body weight. The levels of IgE, IgG1, mMCP-1 (mouse mast cell protease-1), IL-4 and IL-5 in the HDM and HDM + CT (cholera toxin) groups were higher than the control groups, and the levels of IgE, IgG1, IL-4 and IL-5 in the HDM, OVA and HDM + OVA groups were higher than the control groups. The pathological changes of intestinal tissues in the HDM and HDM + CT/the HDM, OVA and HDM + OVA groups were more severe, more eosinophil infiltration than the control groups. Moreover, exposure to HDM induced intestinal barrier dysfunction, and facilitated the development of intestinal allergy in mice. In conclusion, HDM exposure enhances immune responses to OVA-induced food allergy.
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Affiliation(s)
- Jianli Lin
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China.,State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong Province, China
| | - Desheng Chen
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China.,Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Wujin road 85, Shanghai, 200080, China
| | - Lvxin Guan
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China
| | - Kexin Chang
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China
| | - Dan Li
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China
| | - Baoqing Sun
- State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong Province, China.
| | - Pingchang Yang
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China.
| | - Zhigang Liu
- State Key Laboratory of Respiratory Disease Allergy Division at Shenzhen University, Institute of Allergy & Immunology, Shenzhen University School of Medicine, Room 509 of A7 Bldgn, 1066 Xueyuan Blvd, Shenzhen, 518055, China. .,State Key Laboratory of Respiratory Disease, Department of Allergy and Clinical Immunology, National Clinical Center for Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, First Affiliated Hospital, Guangzhou Medical University, 151 Yanjiangxi Road, Guangzhou, 510120, Guangdong Province, China.
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Larson D, Patel P, Salapatek AM, Couroux P, Whitehouse D, Pina A, Johnson JL, Sever ML, Sanda S, Poyser J, Allio T, Scadding GW, Qin T, Shamji MH, Kwok WW, James EA, French D, Lelic A, Larché M, Altman MC, Togias A, Durham SR. Nasal allergen challenge and environmental exposure chamber challenge: A randomized trial comparing clinical and biological responses to cat allergen. J Allergy Clin Immunol 2020; 145:1585-1597. [PMID: 32169380 DOI: 10.1016/j.jaci.2020.02.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The direct-instillation nasal allergen challenge (NAC) and the environmental exposure chamber (EEC) are 2 methods of conducting controlled allergen provocations. The clinical and biological comparability of these methods has not been thoroughly investigated. OBJECTIVE We sought to compare clinical and immunologic responses to cat allergen in NAC versus EEC. METHODS Twenty-four participants were randomized to receive either NAC followed by a 2-day challenge in an EEC or a 2-day challenge in an EEC followed by NAC. Challenges were separated by 28-day washout periods. We measured total nasal symptom scores, peak nasal inspiratory flow, nasal (0-8 hours) and serum cytokines, serum antibodies, peripheral blood antigen-specific T lymphocytes, and gene expression in nasal scrapings. The primary outcome was the total nasal symptom score area under the curve for the first 3 hours after allergen exposure in NAC or after initiation of exposure in EEC. RESULTS Both challenges increased IL-5 and IL-13 in nasal fluids and serum and resulted in altered nasal cell expression of gene modules related to mucosal biology and transcriptional regulation. Changes in gene modules, more so than cytokine measurements, showed significant associations with total nasal symptom score and peak nasal inspiratory flow. Overall, EEC exposure generated larger responses and more early terminations compared with NAC. Although the 2 challenges did not correlate in symptom magnitude or temporality, striking correlations were observed in cytokine levels. CONCLUSIONS Although clinical outcomes of NAC and EEC were temporally different and nonequivalent in magnitude, immunologic responses were similar. Selection of a particular allergen challenge method should depend on considerations of study objectives and cost.
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Affiliation(s)
| | - Piyush Patel
- Inflamax Research Limited, DBA Cliantha Research, Mississauga, Canada
| | | | - Peter Couroux
- Inflamax Research Limited, DBA Cliantha Research, Mississauga, Canada
| | | | - Adela Pina
- Rho Federal Systems Division, Durham, NC
| | | | | | | | - Julian Poyser
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Theresa Allio
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Guy W Scadding
- MRC and Asthma UK, Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Tielin Qin
- The Immune Tolerance Network, Bethesda, Md
| | - Mohamed H Shamji
- MRC and Asthma UK, Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - William W Kwok
- Benaroya Research Institute, Department of Translational Research, Seattle, Wash
| | - Eddie A James
- Benaroya Research Institute, Department of Translational Research, Seattle, Wash
| | | | - Alina Lelic
- Human Immunology Testing Suite, McMaster University, Hamilton, Ontario, Canada
| | - Mark Larché
- McMaster University, Hamilton, Ontario, Canada; Divisions of Clinical Immunology & Allergy and Respirology, Department of Medicine, Firestone Institute of Respiratory Health, The Research Institute, St Joe's Hamilton, Hamilton, Canada
| | - Matthew C Altman
- Department of Medicine, University of Washington, Seattle, Wash; Benaroya Research Institute, Systems Immunology Division, Seattle, Wash
| | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Stephen R Durham
- MRC and Asthma UK, Centre in Allergic Mechanisms of Asthma, London, United Kingdom; Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Section of Inflammation Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Ellis AK. Novel application of the controlled allergen challenge facility model. Ann Allergy Asthma Immunol 2019; 116:481-2. [PMID: 27264561 DOI: 10.1016/j.anai.2016.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/22/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Anne K Ellis
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Abstract
In last 30 to 40 years there has been a significant increase in the incidence of allergy. This increase cannot be explained by genetic factors alone. Increasing air pollution and its interaction with biological allergens along with changing lifestyles are contributing factors. Dust mites, molds, and animal allergens contribute to most of the sensitization in the indoor setting. Tree and grass pollens are the leading allergens in the outdoor setting. Worsening air pollution and increasing particulate matter worsen allergy symptoms and associated morbidity. Cross-sensitization of allergens is common. Treatment involves avoidance of allergens, modifying lifestyle, medical treatment, and immunotherapy.
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Affiliation(s)
- Madhavi Singh
- Department of Family and Community Medicine, Penn State Hershey Medical Group, 1850 East Park Avenue, Suite 207, State College, PA 16803, USA.
| | - Amy Hays
- Department of Family and Community Medicine, Penn State Hershey Medical Group, 303 Benner Pike #1, State College, PA 16803, USA
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Abstract
PURPOSE OF REVIEW The aim of the present review is to discuss updates on research regarding the relationship between indoor allergen exposure and childhood asthma with a focus on clinical effects, locations of exposure, and novel treatments. RECENT FINDINGS Recent data continue to demonstrate that early life sensitization to indoor allergens is a predictor of asthma development later in life. Furthermore, avoidance of exposure to these allergens continues to be important especially given that the vast majority of children with asthma are sensitized to at least one indoor allergen. New research suggests that mouse allergen, more so than cockroach allergen, may be the most relevant urban allergen. Recent evidence reminds us that children are exposed to clinically important levels of indoor allergens in locations away from their home, such as schools and daycare centers. Exposure to increased levels of indoor mold in childhood has been associated with asthma development and exacerbation of current asthma; however, emerging evidence suggests that early exposure to higher fungal diversity may actually be protective for asthma development. Novel treatments have been developed that target TH2 pathways thus decreasing asthmatic responses to allergens. These therapies show promise for the treatment of severe allergic asthma refractory to avoidance strategies and standard therapies. SUMMARY Understanding the relationship between indoor allergens and asthma outcomes is a constantly evolving study of timing, location, and amount of exposure.
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Tong X, Guo M, Jin M, Chen H, Li Y, Wei JF. In silico epitope prediction, expression and functional analysis of Per a 10 allergen from the American cockroach. Int J Mol Med 2016; 38:1806-1814. [PMID: 27840898 PMCID: PMC5117736 DOI: 10.3892/ijmm.2016.2790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 10/21/2016] [Indexed: 01/02/2023] Open
Abstract
Cockroach (CR) allergies caused by the American cockroach hyave been recognized to be repsonsible for IgE-mediated type I hypersensitivity worldwide. Per a 10 is one of the recognized main allergens of the American CR. In a previous study, we examined another American CR allergen, Per a 9 in patients with CR allergies and examined epitope sequences in this allergen. In the present study, we aimed to examine epitope sequences in the Per a 10 allergen. for this purpose, the Per a 10 gene was cloned and expressed in Escherichia coli (E. coli) systems. Our results revealed that 9 out of 16 (56.3%) sera from patients with American CR allergies reacted to Per a10, as assessed by ELISA, confirming that Per a 10 is a major allergen of the American CR. Our results also revealed that the expression of CD63 and CCR3 on passively sensitized basophils (obtained sera of patients with American CR allergies) was increased by approximately 2.3-fold, indicating that recombinant Per a 10 is functionally active. In addition, 3 immunoinformatics tools, namely the DNAStar Protean system, the Bioinformatics Predicted Antigenic Peptides (BPAP) system and the BepiPred 1.0 server were used to predict the peptides and the results revealed 8 peptides (2-12, 55-67, 98-120, 125-133, 149-160, 170-182, 201-208 and 223-227) as potential B cell epitopes of the Per a 10 allergen. Moreover, Per a 10 was predicted to have 3 T cell epitope sequences, namely 83-92, 139-147 and 162-170. The findings of our study on the CR allergen may prove to be useful in the development of peptide-based vaccine for the prevention and/or treatment of CR allergies.
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Affiliation(s)
- Xunliang Tong
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Beijing 100730, P.R. China
| | - Miao Guo
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Min Jin
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Hao Chen
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Yanming Li
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Clinical Research Center for Respiratory Disease, Beijing 100730, P.R. China
| | - Ji-Fu Wei
- Research Division of Clinical Pharmacology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Ahuja SK, Manoharan MS, Harper NL, Jimenez F, Hobson BD, Martinez H, Ingale P, Liu YG, Carrillo A, Lou Z, Kellog DL, Ahuja SS, Rather CG, Esch RE, Ramirez DA, Clark RA, Nadeau K, Andrews CP, Jacobs RL, He W. Preservation of epithelial cell barrier function and muted inflammation in resistance to allergic rhinoconjunctivitis from house dust mite challenge. J Allergy Clin Immunol 2016; 139:844-854. [PMID: 27658763 DOI: 10.1016/j.jaci.2016.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 08/16/2016] [Accepted: 08/19/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND An emerging paradigm holds that resistance to the development of allergic diseases, including allergic rhinoconjunctivitis, relates to an intact epithelial/epidermal barrier during early childhood. Conceivably, the immunologic and genomic footprint of this resistance is preserved in nonatopic, nonallergic adults and is unmasked during exposure to an aeroallergen. OBJECTIVE The aim of this study was to obtain direct support of the epithelial/epidermal barrier model for allergic rhinoconjunctivitis. METHODS Twenty-three adults allergic to house dust mites (HDMs) (M+) and 15 nonsensitive, nonallergic (M-) participants completed 3-hour exposures to aerosolized HDM (Dermatophagoides pteronyssinus) powder on 4 consecutive days in an allergen challenge chamber. We analyzed: (1) peripheral blood leukocyte levels and immune responses; and (2) RNA sequencing-derived expression profiles of nasal cells, before and after HDM exposure. RESULTS On HDM challenge: (1) only M+ persons developed allergic rhinoconjunctivitis symptoms; and (2) peripheral blood leukocyte levels/responses and gene expression patterns in nasal cells were largely concordant between M+ and M- participants; gross differences in these parameters were not observed at baseline (pre-exposure). Two key differences were observed. First, peripheral blood CD4+ and CD8+ T-cell activation levels initially decreased in M- participants versus increased in M+ participants. Second, in M- compared with M+ participants, genes that promoted epidermal/epithelial barrier function (eg, filament-aggregating protein [filaggrin]) versus inflammation (eg, chemokines) and innate immunity (interferon) were upregulated versus muted, respectively. CONCLUSION An imprint of resistance to HDM challenge in nonatopic, nonallergic adults was muted T-cell activation in the peripheral blood and inflammatory response in the nasal compartment, coupled with upregulation of genes that promote epidermal/epithelial cell barrier function.
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Affiliation(s)
- Sunil K Ahuja
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex; Department of Microbiology and Immunology, University of Texas Health Science Center, San Antonio, Tex; Department of Biochemistry, University of Texas Health Science Center, San Antonio, Tex.
| | - Muthu Saravanan Manoharan
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Nathan L Harper
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex; Foundation for Advancing Veterans' Health Research, San Antonio, Tex
| | - Fabio Jimenez
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex; Foundation for Advancing Veterans' Health Research, San Antonio, Tex
| | - Benjamin D Hobson
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy Research, School of Medicine, Stanford University, Stanford, Calif
| | - Hernan Martinez
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex; Foundation for Advancing Veterans' Health Research, San Antonio, Tex
| | - Puraskar Ingale
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Ya-Guang Liu
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Andrew Carrillo
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Zheng Lou
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Dean L Kellog
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Seema S Ahuja
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | | | - Robert E Esch
- School of Natural Sciences, Lenoir-Rhyne University, Hickory, NC
| | | | - Robert A Clark
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
| | - Kari Nadeau
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, Calif; Sean N. Parker Center for Allergy Research, School of Medicine, Stanford University, Stanford, Calif; Division of Allergy, Immunology, and Rheumatology, Lucile Packard Children's Hospital at Stanford Hospital, Stanford, Calif
| | | | | | - Weijing He
- Veterans Administration Center for Personalized Medicine, South Texas Veterans Health Care System, San Antonio, Tex; Department of Medicine, University of Texas Health Science Center, San Antonio, Tex
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