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Gazzinelli-Guimaraes PH, Dulek B, Swanson P, Lack J, Roederer M, Nutman TB. Single-cell molecular signature of pathogenic T helper subsets in type 2-associated disorders in humans. JCI Insight 2024; 9:e177720. [PMID: 38587077 PMCID: PMC11128205 DOI: 10.1172/jci.insight.177720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/14/2024] [Indexed: 04/09/2024] Open
Abstract
To unravel the heterogeneity and molecular signature of effector memory Th2 cells (Tem2), we analyzed 23 individuals' PBMCs of filaria-infected (Filaria+) and 24 healthy volunteers (Filaria-), with or without coincident house dust mite (HDM) allergic sensitization. Flow cytometry revealed 3 CD4+ Tem subsets - CCR4+CCR6+CRTH2- Tem17, CCR4+CCR6-CRTH2+ Tem2, and CCR6+CCR4+CRTH2+ Tem17.2 - markedly enriched in Filaria+ individuals. These subsets were sorted and analyzed by multiomic single-cell RNA immunoprofiling. SingleR-annotated Th2 cells from Tem2 and Tem17.2 cell subsets had features of pathogenic Th2 effector cells based on their transcriptional signatures, with downregulated CD27 and elevated expression levels of ITGA4, IL17RB, HPGDS, KLRB1, PTGDR2, IL9R, IL4, IL5, and IL13 genes. When the Filaria+ individuals were subdivided based on their allergic status, Tem2 cells in HDM+Filaria+ individuals showed an overall reduction in TCR diversity, suggesting the occurrence of antigen-driven clonal expansion. Moreover, HDM+Filaria+ individuals showed not only an expansion in the frequency of both Tem2 and Tem17.2 cell subsets, but also a change in their molecular program by overexpressing GATA3, IL17RB, CLRF2, and KLRB1, as well as increased antigen-induced IL-4, IL-5, and IL-13 production, suggesting that aeroallergens reshape the transcriptional and functional programming of Th2 cell subsets in human filarial infection toward a pathogenic immunophenotype.
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Affiliation(s)
| | | | - Phillip Swanson
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | | | - Mario Roederer
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
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Gibbs L, Fairfax KC. Altered Offspring Immunity in Maternal Parasitic Infections. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 208:221-226. [PMID: 35017211 PMCID: PMC8769501 DOI: 10.4049/jimmunol.2100708] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023]
Abstract
Maternal infection during pregnancy is known to alter the development and function of offspring's immune system, leading to inappropriate immune responses to common childhood infections and immunizations. Although this is an expanding field, maternal parasitic infections remain understudied. Millions of women of reproductive age are currently at risk for parasitic infection, whereas many pregnant, chronically infected women are excluded from mass drug administration due partially to a lack of resources, as well as fear of unknown adverse fetal developmental outcomes. In areas endemic for multiple parasitic infections, such as sub-Saharan Africa, there are increased rates of morbidity and mortality for various infections during early childhood in comparison with nonendemic areas. Despite evidence supporting similar immunomodulatory effects between various parasite species, there is no clear mechanistic understanding of how maternal infection reprograms offspring immunity. This brief review will compare the effects of selected maternal parasitic infections on offspring immunity.
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Affiliation(s)
- Lisa Gibbs
- Department of Pathology, Division of Microbiology and Immunology, University of Utah, Salt Lake City Utah, USA
| | - Keke C. Fairfax
- Department of Pathology, Division of Microbiology and Immunology, University of Utah, Salt Lake City Utah, USA
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Arrais M, Maricoto T, Nwaru BI, Cooper PJ, Gama JM, Brito M, Taborda-Barata L. Helminth infections and allergic diseases: systematic review and meta-analysis of the global literature. J Allergy Clin Immunol 2021; 149:2139-2152. [PMID: 34968529 DOI: 10.1016/j.jaci.2021.12.777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is considerable research interest in the role of helminth infections in the development of allergic diseases. However, findings from previous studies are mixed. Existing systematic reviews of these studies are outdated. We performed a systematic review of the global literature on the association between helminth infections and development and clinical outcomes of allergic diseases. METHODS We searched Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, PubMed, Global Index Medicus, Scielo, KoreaMed, Google Scholar, and Lilacs for studies published up to January 2020. We included observational epidemiological studies (cohort, case-control and cross-sectional studies) of children and adults reporting associations between helminth infections and asthma, allergic rhinitis, eczema and atopy. We performed random-effects meta-analysis to summarize the effect estimates. RESULTS We included 80 studies with 99,967 participants. In the meta-analyses, we did not observe an overall association between helminth infections and allergic diseases. There was, however, evidence that A. lumbricoides infections was associated with an increased risk of bronchial hyperreactivity in children (RR:1.41, 95%CI: 1.17-1.70; I2=50, p for I2=0.09), and was associated with an increased risk of atopy among helminth-infected adults (RR:1.37, 95%CI: 1.18-1.61; I2=52, p for I2=0.02). We found no study that addressed the association between helminth infection and clinical outcomes of allergic diseases. The overall strength of the underlying evidence was low to moderate. CONCLUSION Helminth infections may increase the risk of bronchial hyperreactivity in children and atopy in adults. Well-designed longitudinal cohorts may help clarify potential causal associations between chronic helminth infections and allergic diseases.
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Affiliation(s)
- Margarete Arrais
- Department of Pulmonology, Military Hospital, Luanda, Angola; CISA - Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola; GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal
| | - Tiago Maricoto
- GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal; Aveiro Healthcare Centre, Aveiro-Aradas Family Health Unit, Aveiro, Portugal; Faculty of Health Sciences, University of Beira Interior, CACB-Clinical Academic Centre of Beiras, Covilhã, Portugal.
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Philip J Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK; School of Medicine, International University of Ecuador, Quito, Ecuador
| | - Jorge Mr Gama
- GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal; Centre of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Covilha, Portugal
| | - Miguel Brito
- CISA - Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola; Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Luis Taborda-Barata
- GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal; CICS- Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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Bohnacker S, Troisi F, de Los Reyes Jiménez M, Esser-von Bieren J. What Can Parasites Tell Us About the Pathogenesis and Treatment of Asthma and Allergic Diseases. Front Immunol 2020; 11:2106. [PMID: 33013887 PMCID: PMC7516051 DOI: 10.3389/fimmu.2020.02106] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022] Open
Abstract
The same mechanisms that enable host defense against helminths also drive allergic inflammation. This suggests that pathomechanisms of allergic diseases represent evolutionary old responses against helminth parasites and that studying antihelminth immunity may provide insights into pathomechanisms of asthma. However, helminths have developed an intricate array of immunoregulatory mechanisms to modulate type 2 immune mechanisms. This has led to the hypothesis that the lack of helminth infection may contribute to the rise in allergic sensitization in modern societies. Indeed, the anti-inflammatory potential of helminth (worm) parasites and their products in allergy and asthma has been recognized for decades. As helminth infections bring about multiple undesired effects including an increased susceptibility to other infections, intended helminth infection is not a feasible approach to broadly prevent or treat allergic asthma. Thus, the development of new helminth-based biopharmaceutics may represent a safer approach of harnessing type 2–suppressive effects of helminths. However, progress regarding the mechanisms and molecules that are employed by helminths to modulate allergic inflammation has been relatively recent. The scavenging of alarmins and the modulation of lipid mediator pathways and macrophage function by helminth proteins have been identified as important immunoregulatory mechanisms targeting innate immunity in asthma and allergy. In addition, by regulating the activation of dendritic cells and by promoting regulatory T-cell responses, helminth proteins can counterregulate the adaptive T helper 2 cell response that drives allergic inflammation. Despite these insights, important open questions remain to be addressed before helminth molecules can be used for the prevention and treatment of asthma and other allergic diseases.
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Affiliation(s)
- Sina Bohnacker
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Fabiana Troisi
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Marta de Los Reyes Jiménez
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Julia Esser-von Bieren
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
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Hodžić A, Mateos-Hernández L, Fréalle E, Román-Carrasco P, Alberdi P, Pichavant M, Risco-Castillo V, Le Roux D, Vicogne J, Hemmer W, Auer H, Swoboda I, Duscher GG, de la Fuente J, Cabezas-Cruz A. Infection with Toxocara canis Inhibits the Production of IgE Antibodies to α-Gal in Humans: Towards a Conceptual Framework of the Hygiene Hypothesis? Vaccines (Basel) 2020; 8:E167. [PMID: 32268573 PMCID: PMC7349341 DOI: 10.3390/vaccines8020167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/29/2020] [Indexed: 02/07/2023] Open
Abstract
α-Gal syndrome (AGS) is a type of anaphylactic reaction to mammalian meat characterized by an immunoglobulin (Ig)E immune response to the oligosaccharide α-Gal (Galα1-3Galβ1-4GlcNAc-R). Tick bites seems to be a prerequisite for the onset of the allergic disease in humans, but the implication of non-tick parasites in α-Gal sensitization has also been deliberated. In the present study, we therefore evaluated the capacity of helminths (Toxocara canis, Ascaris suum, Schistosoma mansoni), protozoa (Toxoplasma gondii), and parasitic fungi (Aspergillus fumigatus) to induce an immune response to α-Gal. For this, different developmental stages of the infectious agents were tested for the presence of α-Gal. Next, the potential correlation between immune responses to α-Gal and the parasite infections was investigated by testing sera collected from patients with AGS and those infected with the parasites. Our results showed that S. mansoni and A. fumigatus produce the terminal α-Gal moieties, but they were not able to induce the production of specific antibodies. By contrast, T. canis, A. suum and T. gondii lack the α-Gal epitope. Furthermore, the patients with T. canis infection had significantly decreased anti-α-Gal IgE levels when compared to the healthy controls, suggesting the potential role of this nematode parasite in suppressing the allergic response to the glycan molecule. This rather intriguing observation is discussed in the context of the 'hygiene hypothesis'. Taken together, our study provides new insights into the relationships between immune responses to α-Gal and parasitic infections. However, further investigations should be undertaken to identify T. canis components with potent immunomodulatory properties and to assess their potential to be used in immunotherapy and control of AGS.
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Affiliation(s)
- Adnan Hodžić
- Institute of Parasitology, Department of Pathobiology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria
| | - Lourdes Mateos-Hernández
- UMR BIPAR, INRAE, ANSES, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, 94706 Maisons-Alfort, France; (L.M.-H.); (D.L.R.)
| | - Emilie Fréalle
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019–UMR 8204–CIIL–Center for Infection and Immunity of Lille, University of Lille, F-59000 Lille, France;
- CHU Lille, Laboratory of Parasitology and Mycology, F-59000 Lille, France;
| | - Patricia Román-Carrasco
- Molecular Biotechnology Section, FH Campus Wien, University of Applied Sciences, 1030 Vienna, Austria; (P.R.-C.); (I.S.)
| | - Pilar Alberdi
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC-CSIC-UCLM-JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain; (P.A.); (J.d.l.F.)
| | - Muriel Pichavant
- CHU Lille, Laboratory of Parasitology and Mycology, F-59000 Lille, France;
| | - Veronica Risco-Castillo
- EA 7380 Dynamyc, UPEC, USC, ANSES, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, 94706 Maisons-Alfort, France;
| | - Delphine Le Roux
- UMR BIPAR, INRAE, ANSES, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, 94706 Maisons-Alfort, France; (L.M.-H.); (D.L.R.)
| | - Jérôme Vicogne
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019–UMR9017–CIIL–Center for Infection and Immunity of Lille, University of Lille, F-59000 Lille, France;
| | | | - Herbert Auer
- Department of Medical Parasitology, Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Ines Swoboda
- Molecular Biotechnology Section, FH Campus Wien, University of Applied Sciences, 1030 Vienna, Austria; (P.R.-C.); (I.S.)
| | | | - José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos (IREC-CSIC-UCLM-JCCM), Ronda de Toledo s/n, 13005 Ciudad Real, Spain; (P.A.); (J.d.l.F.)
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK 74078, USA
| | - Alejandro Cabezas-Cruz
- UMR BIPAR, INRAE, ANSES, Ecole Nationale Vétérinaire d’Alfort, Université Paris-Est, 94706 Maisons-Alfort, France; (L.M.-H.); (D.L.R.)
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Kim JY, Yi MH, Yong TS. Allergen-like Molecules from Parasites. Curr Protein Pept Sci 2020; 21:186-202. [DOI: 10.2174/1389203720666190708154300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/02/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023]
Abstract
Parasite infections modulate immunologic responses, and the loss of parasite infections in the
last two to three decades might explain the increased prevalence of allergic diseases in developed countries.
However, parasites can enhance allergic responses. Parasites contain or release allergen-like molecules
that induce the specific immunoglobulin, IgE, and trigger type-2 immune responses. Some parasites
and their proteins, such as Anisakis and Echinococcus granulosus allergens, act as typical allergens.
A number of IgE-binding proteins of various helminthic parasites are cross-reactive to other environmental
allergens, which cause allergic symptoms or hamper accurate diagnosis of allergic diseases. The
cross-reactivity is based on the fact that parasite proteins are structurally homologous to common environmental
allergens. In addition, IgE-binding proteins of parasites might be useful for developing vaccines
to prevent host re-infection. This review discusses the functions of the IgE-biding proteins of parasites.
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Affiliation(s)
- Ju Yeong Kim
- Department of Environmental Medical Biology, Institute of Tropical Medicine, and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Myung-Hee Yi
- Department of Environmental Medical Biology, Institute of Tropical Medicine, and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Tai-Soon Yong
- Department of Environmental Medical Biology, Institute of Tropical Medicine, and Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul 03722, Korea
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Detection of Parasitic Infections in Children with Allergic Rhinitis Compared to Healthy Control in Upper Egypt. IRANIAN JOURNAL OF PEDIATRICS 2019. [DOI: 10.5812/ijp.83995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Santiago HDC, Nutman TB. Role in Allergic Diseases of Immunological Cross-Reactivity between Allergens and Homologues of Parasite Proteins. Crit Rev Immunol 2017; 36:1-11. [PMID: 27480900 DOI: 10.1615/critrevimmunol.2016016545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Implied under the rubric of the hygiene hypothesis is that helminth infection can protect against allergic disease. It is well known that helminths induce processes associated with type 2 immune responses, but they also induce important regulatory responses that can modulate these type 2-associated responses-modulation that influences responses to bystander antigens including allergens. Indeed, most epidemiological studies demonstrate a beneficial effect of helminth infection on atopy, but there are also convincing data to demonstrate that helminth infection can precipitate or worsen allergic inflammation/disease. Reasons for these disparate findings are much debated, but there is a school of thought that suggests that helminth-triggered type 2-associated responses, including IgE to cross-reactive aeroallergens, can offset the regulatory effects imposed by the same organisms. The cross-reactivity among helminths and allergenic tropomyosins dominated the antigen/allergen cross-reactivity field, but recent data suggest that cross-reactivity is much more common than previously appreciated. It has been demonstrated that a high degree of molecular similarity exists between allergens and helminth proteins. Thus, an understanding of the mechanisms underlying the response induced by helminth infection and their impact on the induction of allergic disease in the host are critical for designing therapies using iatrogenic infections or parasite products to treat inflammatory diseases and for developing vaccines against helminth parasites.
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Affiliation(s)
- Helton da Costa Santiago
- Department of Biochemistry and Immunology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, USA
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Oettgen HC. Fifty years later: Emerging functions of IgE antibodies in host defense, immune regulation, and allergic diseases. J Allergy Clin Immunol 2017; 137:1631-1645. [PMID: 27263999 DOI: 10.1016/j.jaci.2016.04.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 01/15/2023]
Abstract
Fifty years ago, after a long search, IgE emerged as the circulating factor responsible for triggering allergic reactions. Its extremely low concentration in plasma created significant hurdles for scientists working to reveal its identity. We now know that IgE levels are invariably increased in patients affected by atopic conditions and that IgE provides the critical link between the antigen recognition role of the adaptive immune system and the effector functions of mast cells and basophils at mucosal and cutaneous sites of environmental exposure. This review discusses the established mechanisms of action of IgE in pathologic immediate hypersensitivity, as well as its multifaceted roles in protective immunity, control of mast cell homeostasis, and its more recently revealed immunomodulatory functions.
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Affiliation(s)
- Hans C Oettgen
- Division of Immunology, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Mass.
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10
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Santiago HC, Nutman TB. Human Helminths and Allergic Disease: The Hygiene Hypothesis and Beyond. Am J Trop Med Hyg 2016; 95:746-753. [PMID: 27573628 DOI: 10.4269/ajtmh.16-0348] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 08/01/2016] [Indexed: 01/22/2023] Open
Abstract
There is much debate about the interaction between helminths and allergic disease. The "Hygiene Hypothesis," a very popular concept among scientists and the lay public, states that infections, especially during childhood, can protect against allergic diseases. Indeed, helminth infections are known to induce regulatory responses in the host that can help the control of inflammation (including allergic inflammation). However, these infections also induce type-2-associated immune responses including helminth-specific IgE that can cross-react against environmental allergens and mediate IgE-driven effector responses. Thus, it is the delicate balance between the parasites' anti- and pro-allergenic effects that define the helminth/allergy interface.
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Affiliation(s)
- Helton C Santiago
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
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Gazzinelli-Guimarães PH, Bonne-Année S, Fujiwara RT, Santiago HC, Nutman TB. Allergic Sensitization Underlies Hyperreactive Antigen-Specific CD4+ T Cell Responses in Coincident Filarial Infection. THE JOURNAL OF IMMUNOLOGY 2016; 197:2772-9. [PMID: 27566825 DOI: 10.4049/jimmunol.1600829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/04/2016] [Indexed: 12/11/2022]
Abstract
Among the various hypotheses put forward to explain the modulatory influence of helminth infection on allergic effector responses in humans, the IL-10-induced suppression of Th2-associated responses has been the leading candidate. To explore this helminth/allergy interaction more fully, parasite- and allergen-specific CD4(+) T cell responses in 12 subjects with filarial infections, and coincident allergic sensitization (filarial [Fil](+)allergy [A](+)) were compared with the responses to three appropriate control groups (Fil(-)A(-) [n = 13], Fil(-)A(+) [n = 12], Fil(+)A(-) [n = 11]). The most important findings revealed that Fil(+)A(+) had marked (p < 0.0001 for all cytokines) increases in parasite Ag-driven Th2 (IL-4, IL-5, IL-13), Th9 (IL-9), and the regulatory (IL-10) cytokines when compared with Fil(+)A(-) Moreover, using multiparameter flow cytometry, filarial parasite Ag induced a marked increase in not only the frequency of CD4(+) T cells producing IL-4, IL-5, IL-2, and TNF-α in Fil(+)A(+) when compared with Fil(+)A(-) patients, but also in the frequencies of polyfunctional Th2-like (CD4(+)IL-4(+)IL-5(+) and CD4(+)IL-2(+)IL-4(+)IL-5(+)TNF-α(+)) cells. The Th2-associated responses seen in the Fil(+)A(+) group were correlated with serum IgE levels (p < 0.01, r = 0.5165 for IL-4; p < 0.001, r = 0.5544 for IL-5; and p < 0.001, r = 0.4901 for IL-13) and levels of circulating eosinophils (p < 0.0116, r = 0.5656) and their degranulation/activation products (major basic protein [p < 0.001, r = 0.7353] and eosinophil-derived neurotoxin [p < 0.01, r = 0.7059]). CD4(+) responses to allergen were not different (to a large extent) among the groups. Taken together, our data suggest that allergic sensitization coincident with filarial infection drives parasite Ag-specific T cell hyperresponsiveness, which is characterized largely by an augmented Th2-dominated immune response.
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Affiliation(s)
- Pedro H Gazzinelli-Guimarães
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892; Department of Parasitology, Biological Sciences Institute, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil; and
| | - Sandra Bonne-Année
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Ricardo T Fujiwara
- Department of Parasitology, Biological Sciences Institute, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil; and
| | - Helton C Santiago
- Department of Immunology and Biochemistry, Biological Sciences Institute, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Thomas B Nutman
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892;
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Takeuchi H, Khan AF, Yunus M, Hasan MI, Hawlader MDH, Takanashi S, Kano H, Zaman K, Chowdhury HR, Wagatsuma Y, Nakahara S, Iwata T. Anti-Ascaris immunoglobulin E associated with bronchial hyper-reactivity in 9-year-old rural Bangladeshi children. Allergol Int 2016; 65:141-146. [PMID: 26666493 DOI: 10.1016/j.alit.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/17/2015] [Accepted: 07/04/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Studies have addressed the immunomodulatory effects of helminths and their protective effects upon asthma. However, anti-Ascaris IgE has been reported to be associated with an increased risk of asthma symptoms. We examined the association between serum levels of anti-Ascaris IgE and bronchial hyper-responsiveness (BHR) in children living in rural Bangladesh. METHODS Serum anti-Ascaris IgE level was measured and the BHR test done in 158 children aged 9 years selected randomly from a general population of 1705 in the Matlab Health and Demographic Surveillance Area of the International Centre for Diarrhoeal Disease Research, Bangladesh. We investigated wheezing symptoms using a questionnaire from the International Study of Asthma and Allergies in Childhood. BHR tests were successfully done on 152 children (108 'current wheezers'; 44 'never-wheezers'). We examined the association between anti-Ascaris IgE level and wheezing and BHR using multiple logistic regression analyses. RESULTS Of 108 current-wheezers, 59 were BHR-positive; of 44 never-wheezers, 32 were BHR-negative. Mean anti-Ascaris IgE levels were significantly higher (12.51 UA/ml; 95% confidence interval (CI), 9.21-17.00) in children with current wheezing with BHR-positive than in those of never-wheezers with BHR-negative (3.89; 2.65-5.70; t test, p < 0.001). A BHR-positive test was independently associated with anti-Ascaris IgE levels with an odds ratio (OR) = 7.30 [95% CI, 2.28-23.33], p = 0.001 when adjusted for total IgE, anti-Dermatophagoides pteronyssinus IgE, pneumonia history, parental asthma, Trichuris infection, forced expiratory volume in one second, eosinophilic leukocyte count, and sex. CONCLUSIONS Anti-Ascaris IgE level is associated with an increased risk of BHR among 9-year-old rural Bangladeshi children.
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Ahumada V, García E, Dennis R, Rojas MX, Rondón MA, Pérez A, Peñaranda A, Barragán AM, Jimenez S, Kennedy MW, Caraballo L. IgE responses to Ascaris and mite tropomyosins are risk factors for asthma. Clin Exp Allergy 2016; 45:1189-200. [PMID: 25702830 DOI: 10.1111/cea.12513] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/06/2015] [Accepted: 02/09/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The relationship between helminthiases and allergy is a matter of considerable interest and research. In the tropics, house dust mite exposure, a known risk factor for asthma, is frequently concurrent with helminth infections. It remains to be defined whether infection with the common roundworm Ascaris or its bystander immunological effects influence the prevalence and pathogenesis of asthma independently of mite sensitization. OBJECTIVE To investigate the relationship between the IgE responses to Ascaris and its purified allergens and the risk of asthma in a tropical country. METHODS A nested case-control study was performed in 356 subjects who reported current and past asthma symptoms (asthmatics) and 435 controls that had never experienced such symptoms. They were tested for serum levels of total IgE and specific IgE to Ascaris extract, Asc s 1 (ABA-1), Asc l 3 (tropomyosin) and GST (glutathione transferase). In addition, specific IgE to Dermatophagoides pteronyssinus, Blomia tropicalis and their tropomyosins Der p 10 and Blo t 10 was measured. Sensitization was defined as a positive specific IgE result to any extract or recombinant allergen. RESULTS Sensitization to Ascaris and D. pteronyssinus was independently associated with asthma after adjustment for age, gender, socio-economic stratum, city and other IgE levels (adjusted ORs: 2.17; 95% CI 1.37-3.42 and 2.46; 95% CI 1.54-3.92), respectively. There was also a significant association with sensitization to the highly allergenic and cross-reactive tropomyosins Asc l 3, Blo t 10 and Der p10 (aORs: 1.76; 95% CI 1.21-2.57, 1.64; 95% CI 1.14-2.35 and 1.51; 95% CI 1.02-2.24), respectively. CONCLUSION AND CLINICAL RELEVANCE IgE responses to Ascaris are associated with asthma symptoms in a population living in the tropics. Sensitization to the cross-reactive Ascaris and mite tropomyosins partially underlies this finding. These results have potential relevance in asthma diagnosis and management.
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Affiliation(s)
- V Ahumada
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - E García
- Division of Pediatric Allergy and Otorhinolaryngology, Fundación Santafé de Bogotá, Bogotá, Colombia
| | - R Dennis
- Research Department, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia.,Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - M X Rojas
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - M A Rondón
- Department of Clinical Epidemiology and Biostatistics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - A Pérez
- Division of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.,Michael & Susan Dell Center for Healthy Living, Austin, TX, USA
| | - A Peñaranda
- Division of Pediatric Allergy and Otorhinolaryngology, Fundación Santafé de Bogotá, Bogotá, Colombia
| | - A M Barragán
- Research Department, Fundación Cardioinfantil - Instituto de Cardiología, Bogotá, Colombia.,Health Sciences Research Center (CICS), Universidad del Rosario, Bogotá, Colombia
| | - S Jimenez
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.,Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
| | - M W Kennedy
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK.,Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, UK
| | - L Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia.,Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
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14
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Suzuki M, Hara M, Ichikawa S, Kamijo S, Nakazawa T, Hatanaka H, Akiyama K, Ogawa H, Okumura K, Takai T. Presensitization to Ascaris antigens promotes induction of mite-specific IgE upon mite antigen inhalation in mice. Allergol Int 2016; 65:44-51. [PMID: 26666495 DOI: 10.1016/j.alit.2015.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 07/02/2015] [Accepted: 07/12/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patients with house dust mite (HDM) allergy or Ascariasis produce serum IgE specific to the antigens of HDM or nematode Ascaris, respectively. Although human IgE cross-reactivity has been reported between HDM and Ascaris antigens, it remains unclear whether it contributes to the pathogenesis of allergic diseases. We herein investigated the induction of cross-reactive antibodies and T cells in mice and effects of airway exposure to HDM antigens after preimmunization with Ascaris antigens. METHODS Mice were intraperitoneally immunized with HDM or Ascaris antigens with Alum, followed by the intranasal administration of HDM antigens. Serum antigen-specific IgE and IgG were measured by ELISA. Cytokine release in splenocytes from Ascaris-immunized mice upon in vitro restimulation with HDM antigens were measured by ELISA. RESULTS Immunization with Ascaris or HDM antigens induced cross-reactive IgG1. Splenocytes from Ascaris-immunized mice released IL-5 and IL-13 in response to the restimulation with HDM antigens. Subsequent airway exposure to HDM antigens promoted the induction of HDM-specific IgE and upregulation of HDM-specific IgG1 in Ascaris-immunized mice, whereas these responses were not detected or smaller without the Ascaris presensitization. CONCLUSIONS We demonstrated that the immunization of naïve mice with Ascaris antigens induced production of antibodies and differentiation of Th2 cells, which were cross-reactive to HDM antigens, and accelerated induction of serum HDM-specific IgE upon subsequent airway exposure to HDM antigens in mice. These results suggest that sensitization to HDM towards IgE-mediated allergic diseases is faster in individuals with a previous history of Ascaris infection than in those without presensitization to Ascaris.
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Affiliation(s)
- Mayu Suzuki
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Materials and Biological Sciences, Faculty of Science, Japan Women's University, Tokyo, Japan
| | - Mutsuko Hara
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Saori Ichikawa
- Department of Materials and Biological Sciences, Faculty of Science, Japan Women's University, Tokyo, Japan
| | - Seiji Kamijo
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takuya Nakazawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan; Department of Rheumatology, Allergy, and Clinical Immunology, National Hospital Organization Chiba-East National Hospital, Chiba, Japan
| | - Hideki Hatanaka
- National Bioscience Database Center, Japan Science and Technology Agency, Tokyo, Japan
| | - Kazuo Akiyama
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Hideoki Ogawa
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ko Okumura
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiro Takai
- Atopy (Allergy) Research Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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15
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Human Ascariasis Increases the Allergic Response and Allergic Symptoms. CURRENT TROPICAL MEDICINE REPORTS 2015. [DOI: 10.1007/s40475-015-0058-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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16
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Buendía E, Zakzuk J, Mercado D, Alvarez A, Caraballo L. The IgE response to Ascaris molecular components is associated with clinical indicators of asthma severity. World Allergy Organ J 2015; 8:8. [PMID: 25780492 PMCID: PMC4347909 DOI: 10.1186/s40413-015-0058-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 01/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Asthma is a common chronic disease worldwide and Ascaris lumbricoides infection (ascariasis) is frequent in tropical regions. However, the effect of ascariasis on asthma severity has not been sufficiently explored. We sought to evaluate the influence of the IgE immune response to Ascaris extract and purified house dust mites (HDM) and Ascaris allergens on indicators of asthma severity in patients living in the tropics. Methods Asthmatic patients from Cartagena, Colombia were recruited. Clinical assessment included questionnaires, physical examination, allergy skin tests, spirometry, parasite stool examination and IgE antibody measurements. Asthma was diagnosed by a physician according to validated criteria. Indicators of severity were occurrence of severe dyspnea episodes, night awakenings events, > 4 emergency room (ER) visits and hospitalizations during the last year. Specific IgE to Der p 2, Ascaris spp., Blomia tropicalis and Dermatophagoides pteronyssinus extracts was determined by ImmunoCap. IgE to tropomyosins (Asc l 3, Blo t 10 and Der p 10), Blo t 5 and Asc s 1 was detected by ELISA. Logistic regression analyses were used to explore the relationships between sensitization and indicators of asthma severity. Results After adjustment for HDM sensitization, Ascaris sensitization remained associated with severe dyspnea (aOR: 1.90, 95% CI: 1.08 - 3.34, p = 0.03) and > 4 ER visits (aOR: 2.23, 95% CI: 1.15 - 4.30, p = 0.02). We also found that sensitization to the species specific markers Blo t 5 and Asc s 1, as well as the cross-reactive tropomyosins of D. pteronyssinus and Ascaris were associated with > 4 ER visits. Der p 2 sensitization was associated with bronchodilator responsiveness (aOR: 2.24: 1.25-4.02, p = 0.01). Remarkably, significantly higher IgE levels to HDM species specific allergens were found in Ascaris sensitized patients. Conclusions In this tropical population, IgE sensitization to Ascaris and the cross-reactive tropomyosins was frequent and associated with clinical indicators of asthma severity. The significant relationship between sensitization to the nematode-specific marker Asc s 1 and ER attendance supports these findings. Moreover, ascariasis increases the human IgE responses to HDM specific allergens.
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Affiliation(s)
- Emiro Buendía
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia ; Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
| | - Dilia Mercado
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Alvaro Alvarez
- Department of Microbiology, Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia ; Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
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17
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Santiago HDC, Ribeiro-Gomes FL, Bennuru S, Nutman TB. Helminth infection alters IgE responses to allergens structurally related to parasite proteins. THE JOURNAL OF IMMUNOLOGY 2014; 194:93-100. [PMID: 25404363 DOI: 10.4049/jimmunol.1401638] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Immunological cross-reactivity between environmental allergens and helminth proteins has been demonstrated, although the clinically related implications of this cross-reactivity have not been addressed. To investigate the impact of molecular similarity among allergens and cross-reactive homologous helminth proteins in IgE-based serologic assessment of allergic disorders in a helminth-infected population, we performed ImmunoCAP tests in filarial-infected and noninfected individuals for IgE measurements to allergen extracts that contained proteins with high levels of homology with helminth proteins as well as IgE against representative recombinant allergens with and without helminth homologs. The impact of helminth infection on the levels and function of the IgE to these specific homologous and nonhomologous allergens was corroborated in an animal model. We found that having a tissue-invasive filarial infection increased the serological prevalence of ImmunoCAP-identified IgE directed against house dust mite and cockroach, but not against timothy grass, the latter with few allergens with homologs in helminth infection. IgE ELISA confirmed that filaria-infected individuals had higher IgE prevalences to those recombinant allergens that had homologs in helminths. Mice infected with the helminth Heligmosomoides polygyrus displayed increased levels of IgE and positive skin tests to allergens with homologs in the parasite. These results show that cross-reactivity among allergens and helminth proteins can have practical implications, altering serologic approaches to allergen testing and bringing a new perspective to the "hygiene hypothesis."
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Affiliation(s)
- Helton da Costa Santiago
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Flávia L Ribeiro-Gomes
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Sasisekhar Bennuru
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892
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18
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Schabussova I, Wiedermann U. Allergy and worms: let's bring back old friends? Wien Med Wochenschr 2014; 164:382-91. [PMID: 25281198 DOI: 10.1007/s10354-014-0308-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 08/20/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW In order to survive in their host, parasitic worms (helminths) have evolved cunning strategies to manipulate the host immune system, some of which may lead to protection from immune dysregulatory diseases such as allergy. Thus, loss of exposure to helminths due to a highly hygienic life style might have contributed to the fact that living in an industrialized country is being associated with an increased prevalence of allergic diseases. However, it must be pointed out that certain helminth infections can in fact induce an allergic phenotype. Factors such as different parasite species, timing of infection in relation to allergic sensitization, or duration and intensity of infection may influence the association between helminth infections and the development or clinical course of allergic disease. In the present article, we review studies that have explored the interaction between helminth infections and allergy in epidemiological and experimental studies. Furthermore, the possibility of using helminths or helminth-derived molecules for the treatment of allergic diseases is discussed with a focus on evidence from clinical trials. RECENT FINDINGS During the past 10 years, many exciting and important studies have found that certain helminth infections protect against the development of allergic diseases. Not surprisingly, several clinical trials investigated the effects of deliberate exposure to parasites like porcine whipworm (Trichuris suis) or hookworm (Necator americanus) to develop "helminth therapies". Although they proved to be a safe option to control aberrant inflammation, the final goal is to identify the parasite-derived immunnomodulatory molecules responsible for protective effects.
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Affiliation(s)
- Irma Schabussova
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Vienna, Austria,
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19
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Ponte EV, Rasella D, Souza-Machado C, Stelmach R, Barreto ML, Cruz AA. Reduced asthma morbidity in endemic areas for helminth infections: a longitudinal ecological study in Brazil. J Asthma 2014; 51:1022-7. [PMID: 24975567 DOI: 10.3109/02770903.2014.936454] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether endemic areas for helminth infections in Brazil have lower rates of hospital admission due to asthma and whether reduction in helminth endemicity impacts on asthma morbidity. METHODS This was a country-wide ecological study in Brazil. Government databases were the source of information. A cross-sectional analysis accessed the risk of a municipality having high rates of hospital admissions due to asthma according to its records of hospital admissions due to Schistossoma mansoni or intestinal helminth infections. A longitudinal analysis accessed the effect of prevention of helminth infection on asthma morbidity. Data were adjusted for the rates of hospital admissions due to influenza, pneumonia, diarrhea, per capita income, Gini index, number of physicians, proportion of literate inhabitants, urbanization and hospital beds. RESULTS Hospitalization rates due to asthma in the age range of 5-24 years were lower in municipalities endemic for S. mansoni [adjusted OR: 0.992, CI: 0.989-0.994] or for intestinal helminth infections [adjusted OR: 0.994, CI: 0.990-0.997]. Similar results were observed for the age range of 25-64 years. In the longitudinal analysis, municipalities that reduced hospitalizations due to S. mansoni had smaller odds to decrease hospital admissions due to asthma among young populations [adjusted OR: 0.43, CI: 0.22-0.82]. CONCLUSION We conclude that populations exposed to helminths have lower asthma morbidity. Reduction of helminth infection prevalence in low-income populations was associated with a smaller decline in asthma morbidity.
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Affiliation(s)
- Eduardo Vieira Ponte
- ProAR - Núcleo de Excelência em Asma, Universidade Federal da Bahia (UFBA) , Salvador , Brazil
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20
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Immunization of Rabbits with NematodeAscaris lumbricoidesAntigens Induces Antibodies Cross-Reactive to House Dust MiteDermatophagoides farinaeAntigens. Biosci Biotechnol Biochem 2014; 77:145-50. [DOI: 10.1271/bbb.120626] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Hawlader MDH, Ma E, Noguchi E, Itoh M, Arifeen SE, Persson LÅ, Moore SE, Raqib R, Wagatsuma Y. Ascaris lumbricoids Infection as a Risk Factor for Asthma and Atopy in Rural Bangladeshi Children. Trop Med Health 2014; 42:77-85. [PMID: 25237284 PMCID: PMC4139537 DOI: 10.2149/tmh.2013-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/09/2013] [Indexed: 02/01/2023] Open
Abstract
Controversy persists as to whether helminth infections cause or protect against asthma and atopy. The aim of this study was to investigate the effects of helminth infection on asthma and atopy among Bangladeshi children. A total of 912 children aged 4.5 years (mean = 54.4, range = 53.5–60.8 months) participated in a cross-sectional study nested into a randomized controlled trial in Bangladesh. Ever-asthma, ever-wheezing and current wheezing were identified using the International Study of Asthma and Allergies in Childhood questionnaire. Current helminth infection was defined by the presence of helminth eggs in stools, measured by routine microscopic examination. Repeated Ascaris infection was defined by the presence of anti-Ascaris IgE ≥ 0.70 UA/ml in serum measured by the CAP-FEIA method. Atopy was defined by specific IgE to house dust mite (anti-DP IgE) ≥ 0.70 UA/ml measured by the CAP-FEIA method and/or positive skin prick test (≥ 5 mm). Anti-Ascaris IgE was significantly associated with ever asthma (odds ratio (OR) = 1.86, 95% CI: 1.14–3.04, highest vs. lowest quartile; P for trend 0.016). Anti-Ascaris IgE was also significantly associated with positive anti-DP IgE (OR = 9.89, 95% CI: 6.52–15.00, highest vs. lowest; P for trend < 0.001) and positive skin prick test (OR = 1.69, 95% CI: 1.01–2.81, highest vs. lowest, P for trend 0.076). These findings suggest that repeated Ascaris infection is a risk factor for asthma and atopy in rural Bangladeshi children. Further analysis is required to examine the mechanism of developing asthma and atopy in relation to helminth infection.
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Affiliation(s)
- Mohammad D H Hawlader
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan ; International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) , Mohakhali, Dhaka 1212, Bangladesh
| | - Enbo Ma
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Emiko Noguchi
- Department of Medical Genetics, Faculty of Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan ; Japan Science and Technology Agency, Core Research for Evolutional Science and Technology (CREST) , 7 Gobancho, Chiyoda-ku, Tokyo 102-0076, Japan
| | - Makoto Itoh
- Department of Infection and Immunology, Aichi Medical University School of Medicine , Nagakute, Aichi 480-1195, Japan
| | - Shams E Arifeen
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) , Mohakhali, Dhaka 1212, Bangladesh
| | - Lars Å Persson
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University , SE-75185 Uppsala, Sweden
| | - Sophie E Moore
- MRC International Nutrition Group, Nutrition and Public Health Intervention Research Unit, Department of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine , Keppel Street, London, WC1E 7HT, United Kingdom
| | - Rubhana Raqib
- International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b) , Mohakhali, Dhaka 1212, Bangladesh
| | - Yukiko Wagatsuma
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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22
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Sitcharungsi R, Sirivichayakul C. Allergic diseases and helminth infections. Pathog Glob Health 2013; 107:110-5. [PMID: 23683364 DOI: 10.1179/2047773213y.0000000080] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The relationships between allergic diseases and helminth infections are inconsistent. Some studies have suggested that helminth infections induce or increase the severity of atopic diseases. Other studies report that children infected with some helminths have lower prevalence and milder atopic symptoms. Expanding our knowledge on the mechanism of immunological modification as a result of helminth infection, and understanding the interaction between helminth infections and allergic diseases will be useful for developing potentially new treatments using some helminths, and for evaluating the risks and benefits of eradicating helminth infections in endemic areas. This article reviews current knowledge on the mechanisms of allergic disease, the immunological modifications that result from helminth infections, and clinical evidence of the effects of these infections on allergic diseases.
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Affiliation(s)
- Raweerat Sitcharungsi
- Department of Tropical Pediatric, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Inhibitory action of quercetin on eosinophil activation in vitro. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:127105. [PMID: 23840245 PMCID: PMC3690238 DOI: 10.1155/2013/127105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/15/2013] [Accepted: 05/22/2013] [Indexed: 01/27/2023]
Abstract
The influence of quercetin on eosinophil functions was examined in vitro and in vivo. The first set of experiments was undertaken to examine whether quercetin could suppress eosinophilia and IgE hyperproduction induced by Mesocestoides corti infection in BALB/c mice. The number of peripheral blood eosinophils and IgE levels were examined 21 days after infection. Oral administration of quercetin for 21 days could not suppress both peripheral blood eosinophilia and IgE hyperproduction, even when 20.0 mg/kg quercetin was used for treatment. The second part of the experiment was designed to examine the influence of quercetin on eosinophil activation induced by SCF stimulation in vitro. Eosinophils were obtained from M. corti-infected mice and stimulated with SCF in the presence of various concentrations of quercetin for 24 h. The addition of quercetin into cell cultures could suppress eosinophil activation induced by SCF stimulation as assessed by measuring the contents of RANTES, MIP-1β, ECP, and MBP in culture supernatants. The minimum concentration of quercetin which caused significant suppression of factor secretion was 5.0 μM. These results may suggest that quercetin will be a good candidate for the supplement on the management of eosinophil-mediated diseases, such as allergic rhinitis and asthma.
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New Allergens of Relevance in Tropical Regions: The Impact of Ascaris lumbricoides Infections. World Allergy Organ J 2013; 4:77-84. [PMID: 23282442 PMCID: PMC3651106 DOI: 10.1097/wox.0b013e3182167e04] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
One of the many aspects of the relationships between parasite infections and allergic diseases is the possibility that allergens from parasites enhance the TH2 responses, especially IgE production, in allergic diseases such as asthma. In this review we discuss about the allergenic composition of the nematode Ascaris lumbricoides and their potential impact on allergy sensitization and asthma pathogenesis and prevalence in populations living in the tropics and naturally exposed to both, mite allergens and helminth infections.
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25
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Abstract
From an article published by our group by Medeiros et al, we discuss and review the literature on the role of serum specific anti-ascaris IgE in patients with respiratory allergies living in countries where helminthic infestations are common. Medeiros et al conducted a study using 101 patients aged 12 to 21 years with respiratory allergy. Median IgE level was 660 IU/mL. Serum specific anti-ascaris IgE was positive in 73% (74/101) of the individuals, but parasitological stool examination yielded positive results in only 33.7% (34/101). The correlation coefficient between serum total IgE level and serum specific anti-ascaris IgE was 0.52 (P < 0.001) and this effect occurred regardless of eosinophil count and of the presence of intestinal helminthic infection. In patients with respiratory allergy with very high serum total IgE levels, in whom the past or present history of parasitic infection is a possible explanation, the presence of serum specific anti-ascaris IgE was common and should be better evaluated in allergic patients from Ascaris lumbricoides endemic areas.
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Santiago HDC, Bennuru S, Ribeiro JMC, Nutman TB. Structural differences between human proteins and aero- and microbial allergens define allergenicity. PLoS One 2012; 7:e40552. [PMID: 22815762 PMCID: PMC3399830 DOI: 10.1371/journal.pone.0040552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 06/08/2012] [Indexed: 01/28/2023] Open
Abstract
The current paradigm suggests that structural homology of allergenic proteins to microbial (particularly helminths) or human proteins underlie their allergenic nature. To examine systematically the structural relationships among allergens and proteins of pathogens (helminths, protozoans, fungi and bacteria) as they relate to allergenicity, we compared the amino acid sequence of 499 molecularly-defined allergens with the predicted proteomes of fifteen known pathogens, including Th2 inducing helminths and Th1-inducing protozoans, and humans using a variety of bioinformatic tools. Allergenicity was assessed based on IgE prevalences using publicly accessible databases and the literature. We found multiple homologues of common allergens among proteins of helminths, protozoans, fungi and humans, but not of bacteria. In contrast, 187 allergens showed no homology with any of the microbial genera studied. Interestingly, allergens without homologues or those with limited levels of sequence conservation were the most allergenic displaying high IgE prevalences in the allergic population. There was an inverse relationship between allergenicity and amino acid conservation levels with either parasite, including helminth, or human proteins. Our results suggest that allergenicity may be associated with the relative "uniqueness" of an antigen, i.e. immunogenicity, while similarity would lead to immunological tolerance.
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Affiliation(s)
- Helton da Costa Santiago
- The Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Sasisekhar Bennuru
- The Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - José M. C. Ribeiro
- Laboratory of Malaria and Vector Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America
| | - Thomas B. Nutman
- The Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Santiago HC, LeeVan E, Bennuru S, Ribeiro-Gomes F, Mueller E, Wilson M, Wynn T, Garboczi D, Urban J, Mitre E, Nutman TB. Molecular mimicry between cockroach and helminth glutathione S-transferases promotes cross-reactivity and cross-sensitization. J Allergy Clin Immunol 2012; 130:248-56.e9. [PMID: 22541242 PMCID: PMC3387355 DOI: 10.1016/j.jaci.2012.02.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 02/03/2012] [Accepted: 02/16/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The extensive similarities between helminth proteins and allergens are thought to contribute to helminth-driven allergic sensitization. OBJECTIVE The objective of this study was to investigate the cross-reactivity between a major glutathione-S transferase allergen of cockroach (Bla g 5) and the glutathione-S transferase of Wuchereria bancrofti (WbGST), a major lymphatic filarial pathogen of humans. METHODS We compared the molecular and structural similarities between Bla g 5 and WbGST by in silico analysis and by linear epitope mapping. The levels of IgE, IgG, and IgG(4) antibodies were measured in filarial-infected and filarial-uninfected patients. Mice were infected with Heligmosomoides bakeri, and their skin was tested for cross-reactive allergic responses. RESULTS These 2 proteins are 30% identical at the amino acid level with remarkable similarity in the N-terminal region and overall structural conservation based on predicted 3-dimensional models. Filarial infection was associated with IgE, IgG, and IgG(4) anti-Bla g 5 antibody production, with a significant correlation between antibodies (irrespective of isotype) to Bla g 5 and WbGST (P< .0003). Preincubation of sera from cockroach-allergic subjects with WbGST partially depleted (by 50%-70%) anti-Bla g 5 IgE, IgG, and IgG(4) antibodies. IgE epitope mapping of Bla g 5 revealed that 2 linear N-terminal epitopes are highly conserved in WbGST corresponding to Bla g 5 peptides partially involved in the inhibition of WbGST binding. Finally, mice infected with H bakeri developed anti-HbGST IgE and showed immediate-type skin test reactivity to Bla g 5. CONCLUSION These data demonstrate that helminth glutathione-S transferase and the aeroallergen Bla g 5 share epitopes that can induce allergic cross-sensitization.
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Affiliation(s)
- Helton C Santiago
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.
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Choi MH, Chang YS, Lim MK, Bae YM, Hong ST, Oh JK, Yun EH, Bae MJ, Kwon HS, Lee SM, Park HW, Min KU, Kim YY, Cho SH. Clonorchis sinensis infection is positively associated with atopy in endemic area. Clin Exp Allergy 2012; 41:697-705. [PMID: 21488996 DOI: 10.1111/j.1365-2222.2011.03746.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidemiologic studies have suggested that helminth infections play a protective role against allergy; this inverse association, however, has not been consistent. Clonorchis sinensis, the liver fluke of human, is prevalent in the Far East. The association between C. sinensis infection and allergy has not yet been reported. OBJECTIVE We evaluated the association between clonorchiasis and atopy or allergic diseases in adults in endemic areas of clonorchiasis. METHODS A total of 1116 subjects (males 419, females 697; age range, 30-86; mean age=61 years) were recruited from two endemic areas of C. sinensis in Korea. Clonorchiasis was confirmed by stool examination. Allergic symptoms were evaluated with a modified ISAAC questionnaire, and atopy was defined by skin prick test for common inhalant allergens. Total serum IgE and C. sinensis-specific IgE level was measured by ELISA and methacholine bronchial provocation test was performed to evaluate airway hyperresponsiveness (AHR). RESULTS Clonorchiasis was positively associated with atopy [odds ratio (OR), 1.856; 95% confidence interval (CI), 1.199-2.873] and high levels of total serum IgE (OR, 1.455; 95% CI, 1.050-2.016). Higher association with clonorchiasis was shown in subjects who showed both atopy and high total serum IgE levels (OR, 2.540; 95% CI, 1.448-4.455). Clonorchiasis had no association with wheezing, AHR, asthma or allergic rhinitis. CONCLUSION AND CLINICAL RELEVANCE Clonorchiasis was positively associated with atopy in adults in endemic area.
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Affiliation(s)
- M-H Choi
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul, Korea
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Flohrs K, Brüske I, Thiering E, Rzehak P, Wichmann HE, Heinrich J. Temporal Changes in Total Serum Immunoglobulin E Levels in East German Children and the Effect of Potential Predictors. Int Arch Allergy Immunol 2012; 158:27-34. [DOI: 10.1159/000329855] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 05/27/2011] [Indexed: 11/19/2022] Open
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Modulation of specific and allergy-related immune responses by helminths. J Biomed Biotechnol 2011; 2011:821578. [PMID: 22219659 PMCID: PMC3248237 DOI: 10.1155/2011/821578] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 09/09/2011] [Indexed: 01/10/2023] Open
Abstract
Helminths are master regulators of host immune responses utilising complex mechanisms to dampen host protective Th2-type responses and favour long-term persistence. Such evasion mechanisms ensure mutual survival of both the parasite and the host. In this paper, we present recent findings on the cells that are targeted by helminths and the molecules and mechanisms that are induced during infection. We discuss the impact of these factors on the host response as well as their effect in preventing the development of aberrant allergic inflammation. We also examine recent findings on helminth-derived molecules that can be used as tools to pinpoint the underlying mechanisms of immune regulation or to determine new anti-inflammatory therapeutics.
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31
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Smedt SD, Nkurikiye J, Fonteyne Y, Hogewoning A, Esbroeck MV, Bacquer DD, Tuft S, Gilbert C, Delanghe J, Kestelyn P. Vernal keratoconjunctivitis in school children in Rwanda and its association with socio-economic status: a population-based survey. Am J Trop Med Hyg 2011; 85:711-7. [PMID: 21976577 PMCID: PMC3183782 DOI: 10.4269/ajtmh.2011.11-0291] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 07/13/2011] [Indexed: 11/07/2022] Open
Abstract
Vernal keratoconjunctivitis (VKC) is an allergic eye disease and an important cause of hospital referral among children in Africa and Asia. Hospital-based studies have suggested a role for parasites in its pathogenesis. To determine the prevalence and risk factors for VKC in Central Africa, we conducted a nested population-based case control study in Rwanda, involving randomly selected primary schools from different environments (rural/urban) and climate. A prevalence of VKC of 4.0% (95% confidence interval 3.3-4.7%) was found among 3,041 children studied (participation rate 94.7%). The intestinal parasitic burden was not related to VKC. Besides hot dry climate (odds ratio [OR] = 1.5, P = 0.05) and male gender (OR = 1.7, P = 0.005), multivariate analysis identified higher economic status as a risk for VKC (OR = 1.4, P = 0.005). The effect on VKC of higher economic status appears not to act through differences in parasitic intestinal load.
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Affiliation(s)
- Stefan De Smedt
- Ophthalmology Department, Kabgayi Hospital, Muhanga, Rwanda.
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32
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Acevedo N, Caraballo L. IgE cross-reactivity between Ascaris lumbricoides and mite allergens: possible influences on allergic sensitization and asthma. Parasite Immunol 2011; 33:309-21. [PMID: 21388422 DOI: 10.1111/j.1365-3024.2011.01288.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nematode infections such as Ascariasis are important health problems in underdeveloped countries, most of them located in the tropics where environmental conditions also promote the perennial co-exposure to high concentrations of domestic mite allergens. Allergic diseases are common, and most of patients with asthma exhibit a predominant and strong IgE sensitization to mites. It is unknown whether co-exposure to Ascaris lumbricoides and the domestic mites Blomia tropicalis and Dermatophagoides pteronyssinus potentiates Th2 responses and IgE sensitization, thereby modifying the natural history of allergy. Recently, we obtained experimental evidence of a high cross-reactivity between the allergenic extracts of these invertebrates, involving well-known allergens such as tropomyosin and glutathione transferases. There is indirect evidence suggesting that the clinical impact of these findings may be important. In this review, we discuss the potential role of this cross-reactivity on several aspects of allergy in the tropics that have been a focus of a number of investigations, some of them with controversial results.
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Affiliation(s)
- N Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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33
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Koskinen JP, Laatikainen T, von Hertzen L, Vartiainen E, Haahtela T. IgE response to Ascaris lumbricoides in Russian children indicates IgE responses to common environmental allergens. Allergy 2011; 66:1122-3. [PMID: 21366606 DOI: 10.1111/j.1398-9995.2011.02572.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J-P Koskinen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, PO Box 30, FI-00271, Helsinki, Finland.
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Abstract
Food allergy seems to represent a new spectrum of disease that has elicited significant community concern and extended waiting lists for allergists and gastroenterologists alike. The apparent rise in prevalence of IgE-mediated food allergy (and associated risk of anaphylaxis) has been postulated to result from effects of a "modern lifestyle" but as yet clear environmental risk factors have not yet emerged. Family history seems to contribute to risk suggesting that gene-environment interactions will be important for identifying a subpopulation with increased susceptibility to any identified lifestyle effects. Non-IgE-mediated food allergy (including food-induced enteropathies and colitides, eosinophilic esophagitis, and Crohn's disease) with potentially similar environmental triggers resulting in diverse immune dysregulatory mechanisms. The evidence underpinning the putative rise in food allergy is discussed and potential mechanisms of disease explored. Clinical aspects of various food allergic conditions including non-IgE-mediated food allergy are outlined.
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Link between allergic asthma and airway mucosal infection suggested by proteinase-secreting household fungi. Mucosal Immunol 2009; 2:504-17. [PMID: 19710638 PMCID: PMC4115785 DOI: 10.1038/mi.2009.102] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Active fungal proteinases are powerful allergens that induce experimental allergic lung disease strongly resembling atopic asthma, but the precise relationship between proteinases and asthma remains unknown. Here, we analyzed dust collected from the homes of asthmatic children for the presence and sources of active proteinases to further explore the relationship between active proteinases, atopy, and asthma. Active proteinases were present in all houses and many were derived from fungi, especially Aspergillus niger. Proteinase-active dust extracts were alone insufficient to initiate asthma-like disease in mice, but conidia of A. niger readily established a contained airway mucosal infection, allergic lung disease, and atopy to an innocuous bystander antigen. Proteinase produced by A. niger enhanced fungal clearance from lung and was required for robust allergic disease. Interleukin 13 (IL-13) and IL-5 were required for optimal clearance of lung fungal infection and eosinophils showed potent anti-fungal activity in vitro. Thus, asthma and atopy may both represent a protective response against contained airway infection due to ubiquitous proteinase-producing fungi.
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Abstract
PURPOSE OF REVIEW To review the findings of recent human studies of the association between helminth parasite infections and allergy and discuss their potential relevance to public health. RECENT FINDINGS Different helminth parasites may have different effects on allergy that may depend on the timing or intensity of the exposure or host genetic factors. Infections with Trichuris trichiura in early life are associated with a reduced prevalence of allergen skin test reactivity later in life and infants of helminth-infected mothers have been reported to have a reduced prevalence of eczema. Hookworm infection has been associated with a reduced prevalence of asthma in Ethiopia. Several studies have reported that anti-Ascaris IgE is an important risk factor for asthma, but this could be explained by an enhanced ability of atopics to produce IgE. Toxocara infections may be associated with an increased risk of wheeze in some populations that may be caused by the host response to the parasite or by parasite-enhanced Th2 responses to aeroallergens. SUMMARY Although helminth infections can modulate the host inflammatory response directed against the parasite, a causal association between helminths and atopic diseases remains uncertain.
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Acevedo N, Mercado D, Vergara C, Sánchez J, Kennedy MW, Jiménez S, Fernández AM, Gutiérrez M, Puerta L, Caraballo L. Association between total immunoglobulin E and antibody responses to naturally acquired Ascaris lumbricoides infection and polymorphisms of immune system-related LIG4, TNFSF13B and IRS2 genes. Clin Exp Immunol 2009; 157:282-90. [PMID: 19604268 DOI: 10.1111/j.1365-2249.2009.03948.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The 13q33-34 region harbours a susceptibility locus to Ascaris lumbricoides, although the underlying genes are unknown. Immunoglobulin (Ig)E and IgG confer protective immunity and here we sought to investigate in an endemic population whether LIG4, TNFSF13B and IRS2 genes influence IgE and IgG levels against Ascaris and the ABA-1 allergen as a putative resistance marker. Mite-allergic asthmatic patients were analysed for potential relationships between Ascaris predisposition and allergy. One thousand and sixty-four subjects from Cartagena, Colombia, were included. Single nucleotide polymorphisms (SNPs) were genotyped using TaqMan assays. Antibody levels were measured by enzyme-linked immunosorbent assay. Linear and logistic regressions were used to model effects of genotypes on antibody levels. The GG genotype of LIG4 (rs1805388) was associated with higher IgE levels to Ascaris compared with other genotypes. TNFSF13B (rs10508198) was associated positively with IgG levels against Ascaris extract and IgE levels against ABA-1. In asthmatics, IRS2 (rs2289046) was associated with high total IgE levels. Associations held up after correction by population stratification using a set of 52 ancestry markers, age, sex and disease status. There was no association with asthma or mite sensitization. In a tropical population, LIG4 and TNFSF13B polymorphisms are associated with specific IgE and IgG to Ascaris, supporting previous linkage studies implicating the 13q33 region. Our results suggest that genes protecting against parasite infections can be different to those predisposing to asthma and atopy.
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Affiliation(s)
- N Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
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Pinelli E, Willers SM, Hoek D, Smit HA, Kortbeek LM, Hoekstra M, de Jongste J, van Knapen F, Postma D, Kerkhof M, Aalberse R, van der Giessen JWB, Brunekreef B. Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study. Eur J Clin Microbiol Infect Dis 2009; 28:1327-34. [PMID: 19644714 DOI: 10.1007/s10096-009-0785-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 07/11/2009] [Indexed: 11/28/2022]
Abstract
The association between helminth infections and childhood atopic diseases remains controversial. The majority of studies have been carried out in tropical areas, whereas less information is available from western countries with low intensity of helminth infections. In the Netherlands, the infection of pigs with Ascaris suum is very common, particularly on pig farms with outdoor facilities. This helminth can also infect humans, causing visceral larva migrans. This study aims at determining the prevalence of antibodies against A. suum and its association with allergic symptoms and sensitisation in a population of 4-year-old children living in The Netherlands. Blood samples from 629 children from the prospective birth cohort Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study were examined for Ascaris antibodies. Data on allergic symptoms and sensitisation were collected using questionnaires and radioallergosorbent tests (RAST). A total of 45 out of 629 (7%) were found to be Ascaris-seropositive. In addition, a positive association between Ascaris seropositivity and wheeze in the last year, doctor-diagnosed asthma and food and aero-allergen sensitisation was found. These results support the hypothesis that low-level or transient infection with helminths enhances allergic reactivity.
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Affiliation(s)
- E Pinelli
- Department of Parasitology and Mycology, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.
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Can helminths or helminth-derived products be used in humans to prevent or treat allergic diseases? Trends Immunol 2009; 30:75-82. [DOI: 10.1016/j.it.2008.11.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/03/2008] [Accepted: 11/03/2008] [Indexed: 01/06/2023]
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Reddy A, Fried B. Atopic disorders and parasitic infections. ADVANCES IN PARASITOLOGY 2008; 66:149-91. [PMID: 18486690 DOI: 10.1016/s0065-308x(08)00203-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This chapter examines the relationship between atopic disorders and parasitic infections. Atopy is an exaggerated IgE-mediated Type-1 immune response in predisposed individuals. Conflicting information exists in regard to the relationship of parasitic infections and the classic allergic diseases, that is, atopic dermatitis, allergic rhinitis and asthma. Attention is paid to the explanations for these discrepancies in the literature found within both human and animal studies on atopy with particular emphasis on helminthic infections. The factors that cause only a proportion of atopic individuals to develop clinical disease have not been defined although helminths confer protection in many studies examined. Early childhood infections help induce a Th1-biased immunity and prevent the induction of the Th2 system that causes atopy. Acute parasitic infections may increase manifestations of allergy, whereas chronic infections with parasites decrease atopic predisposition. Nonetheless, a causal association between geohelminth infection and atopic disorders has not been established. Some helminthic substances, especially the cytokines, have respiratory and anti-allergic effects, and may therefore become useful as therapeutic modalities for many atopic and allergic disorders.
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Affiliation(s)
- Aditya Reddy
- Department of Biology, Lafayette College, Easton, Pennsylvania 18042, USA
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41
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Daschner A, Cuéllar C, Valls A. Towards a differential definition of atopy: Anisakis simplex and the relationship between parasites and arthropods in respiratory allergy. Parasite Immunol 2008; 30:417-24. [PMID: 18507783 DOI: 10.1111/j.1365-3024.2008.01041.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Protective as well as enhancing effects of parasite infections on allergic disease have been postulated. Previous studies on this relationship focused frequently on skin test reactivity against aeroallergens, being house dust mites (HDM) the main agents responsible for a positive atopy outcome. We aimed to analyse the possible relationship between human parasite infection induced Anisakis simplex urticaria and respiratory allergy. A total of 86 patients with gastro-allergic Anisakiasis and 203 patients with chronic urticaria sensitized against A. simplex were studied for sensitization against aeroallergens and evaluated for rhinoconjunctivitis or bronchial asthma (RCBA). We compared the results with a control group of 250 consecutive patients referred for evaluation of allergic RCBA and atopy prevalence data of our region. Whereas no effect of A. simplex related disease on the overall allergic respiratory disease could be detected, a highly significant higher prevalence of RCBA associated HDM sensitization, but diminished allergy against other common aeroallergens (pollen, mould or dander) was observed in these groups. The relationship between A. simplex parasitism-associated acute or chronic urticaria on one side and allergic respiratory disease on the other side depends on the definition of atopy. We propose a differential definition of atopy, with a special emphasis on arthropod related sensitization.
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Affiliation(s)
- A Daschner
- Hospital Universitario La Princesa, Servicio de Alergia, Madrid, Spain.
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Pinelli E, Brandes S, Dormans J, Gremmer E, van Loveren H. Infection with the roundworm Toxocara canis leads to exacerbation of experimental allergic airway inflammation. Clin Exp Allergy 2008; 38:649-58. [DOI: 10.1111/j.1365-2222.2007.02908.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ponte EV, Rizzo JA, Cruz AA. Interrelationship among asthma, atopy, and helminth infections. J Bras Pneumol 2008; 33:335-42. [PMID: 17906796 DOI: 10.1590/s1806-37132007000300016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2006] [Accepted: 10/15/2006] [Indexed: 12/14/2022] Open
Abstract
To describe the principal evidence in the literature regarding the interrelationship among helminth infections, atopy, and asthma, a nonsystematic review of the literature was conducted. Among the publications on the subject, we found a number in which there was controversy regarding the capacity of geohelminth infections to inhibit responsiveness to skin allergy tests and to minimize the symptoms of allergic diseases. However, although small in number, studies of patients infected with Schistosoma spp. suggest that these helminths can inhibit the responsiveness to skin allergy testing and minimize asthma symptoms. Evidence provided by in vitro studies suggests that helminthiases inhibit T helper 1- and T helper 2-type immune responses. This opens new therapeutic possibilities for the treatment of immune system diseases.
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Affiliation(s)
- Eduardo Vieira Ponte
- Programa de Pós-Graduação em Medicina e Saúde, Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil.
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Hamelmann E, Beyer K, Gruber C, Lau S, Matricardi PM, Nickel R, Niggemann B, Wahn U. Primary prevention of allergy: avoiding risk or providing protection? Clin Exp Allergy 2007; 38:233-45. [PMID: 18081883 DOI: 10.1111/j.1365-2222.2007.02901.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Primary prevention strategies of allergy so far have been aimed to fight allergy causes, by avoiding risk factors and inhibiting their mechanisms of action. The results of trials testing food or airborne allergen avoidance as a prevention strategy were, however, rather disappointing. A reverse approach for primary prevention of allergies aims to facilitate exposure to protecting factors which promote the induction of immunologic tolerance against innocuous antigens. These factors are associated with farming environment and a 'traditional lifestyle', but identification of these factors is quite difficult. Major candidates include food-borne microbes, helminths or their components, which are able to stimulate mucosal immunity, particularly in the gut. Similarly, new preventive and therapeutic strategies are being tested to induce specific food-allergen oral tolerance through the ingestion of progressively increasing doses of the offending food. This shifting of allergy prevention research from avoidance to tolerance induction will hopefully allow us to reverse the epidemic trend of allergy diseases.
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Affiliation(s)
- E Hamelmann
- Department of Pediatric Pneumology and Immunology, Charité, Universitätsmedizin, Berlin, Germany.
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45
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Takeuchi H, Zaman K, Takahashi J, Yunus M, Chowdhury HR, Arifeen SE, Baqui A, Wakai S, Iwata T. High titre of anti-Ascaris immunoglobulin E associated with bronchial asthma symptoms in 5-year-old rural Bangladeshi children. Clin Exp Allergy 2007; 38:276-82. [PMID: 18070165 DOI: 10.1111/j.1365-2222.2007.02890.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increasing interest has arisen whether helminthic infections protect against asthma and allergy. The prevalence of wheezing among Bangladeshi children is higher in rural areas where helminthic infectious burden is greater, which is contrary to the general assumption. OBJECTIVE We therefore examined the association between Ascaris infection, serum level of anti-Ascaris IgE, which should be investigated differently from the infection, and wheezing in 5-year-old children from rural Bangladesh. METHODS A total of 219 children who reported wheezing during the previous 12 months and 122 randomly selected age-matched individuals who had never experienced wheezing were tested for serum levels of total and specific Ascaris, Dermatophagoides pteronyssinus, alternaria and cockroach IgEs, and for intestinal helminth infection as well. RESULTS Anti-Ascaris IgE levels were significantly and independently associated with current wheezing during the previous 12 months [odds ratio (OR) per log(e) increment is 1.31 (95% confidence interval (CI) 1.08-1.60), P=0.007], a history of at least four episodes of wheezing [OR per log(e) increment is 1.52 (95% CI 1.18-1.96), P=0.001], wheezing with sleep disturbances [OR per log(e) increment is 1.35 (95% CI 1.10-1.64), P=0.011] and wheezing with speech disturbances [OR per log(e) increment is 1.57 (95% CI 1.19-2.08), P=0.001]. These were adjusted for gender, pneumonia history, parental asthma, Trichuris infection, use of dry leaves as fuel and other specific IgE levels. The prevalence of Ascaris infection by the presence of wheezing was not significantly different (76% vs. 72%, respectively). CONCLUSION We conclude that a high titre of anti-Ascaris IgE is associated with an increased risk of asthma symptoms among 5-year-old rural Bangladeshi children with a high helminthic infectious load.
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Affiliation(s)
- H Takeuchi
- Department of International Community Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Hunninghake GM, Soto-Quiros ME, Avila L, Ly NP, Liang C, Sylvia JS, Klanderman BJ, Silverman EK, Celedón JC. Sensitization to Ascaris lumbricoides and severity of childhood asthma in Costa Rica. J Allergy Clin Immunol 2007; 119:654-61. [PMID: 17336615 DOI: 10.1016/j.jaci.2006.12.609] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 11/30/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little is known about sensitization (defined as a positive IgE) to helminths and disease severity in patients with asthma. OBJECTIVES To examine the relationship between sensitization (defined as a positive IgE) to Ascaris lumbricoides and measures of asthma morbidity and severity in a Costa Rican population with low prevalence of parasitic infection but high prevalence of parasitic exposure. METHODS Cross-sectional study of 439 children (ages 6 to 14 years) with asthma. Linear regression and logistic regression were used for the multivariate statistical analysis. RESULTS After adjustment for parental education and other covariates, sensitization to Ascaris lumbricoides was associated with having at least 1 positive skin test to allergens (odds ratio, 5.15; 95% CI, 2.36-11.21; P < .001), increased total serum IgE and eosinophils in peripheral blood, reductions in FEV(1) and FEV(1)/forced vital capacity, increased airway responsiveness and bronchodilator responsiveness, and hospitalizations for asthma in the previous year (odds ratio, 3.08; 95% CI, 1.23-7.68; P = .02). CONCLUSION Sensitization to Ascaris lumbricoides is associated with increased severity and morbidity of asthma among children in Costa Rica. This association is likely mediated by an increased degree of atopy among children with asthma who are sensitized to Ascaris. CLINICAL IMPLICATIONS In areas with a low prevalence of helminthiasis such as Costa Rica, Ascaris sensitization may be an important marker of severe atopy and disease morbidity in children with asthma.
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Affiliation(s)
- Gary M Hunninghake
- Channing Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Fallon PG, Mangan NE. Suppression of TH2-type allergic reactions by helminth infection. Nat Rev Immunol 2007; 7:220-30. [PMID: 17318233 DOI: 10.1038/nri2039] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is no immunological mechanism to adequately explain the sudden epidemic in allergies noted in the last 30 years in developed countries. The reduction in the development of allergic disorders observed in individuals infected with parasitic helminths, however, supports a possible role for worms in suppressing allergies. Helminths regulate the immunity of the host to ensure a mutually beneficial environment for the survival of both the parasite and the host. This interplay between helminths and allergic responses raises fundamental questions in immunobiology. Harnessing current mechanistic studies for translational research into helminth infections and atopy might have potential for the identification of novel biomarkers, and even therapeutics, in allergic diseases.
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Affiliation(s)
- Padraic G Fallon
- Institute of Molecular Medicine, Department of Clinical Medicine, Trinity College Dublin Centre for Health Sciences, St James's Hospital, Dublin, Ireland.
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Di Lorenzo G, Pacor ML, Mansueto P, Esposito-Pellitteri M, Scichilone N, Ditta V, Lo Bianco C, Leto-Barone MS, Di Fede G, Corrocher R, Mansueto S, Rini GB. Relationship between specific serum IgE to Ascaris lumbricoides and onset of respiratory symptoms in Bangladesh immigrants. Int J Immunopathol Pharmacol 2006; 19:629-38. [PMID: 17026848 DOI: 10.1177/039463200601900319] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The role of helminths in asthma and/or rhinitis and in allergic sensitization is still unclear. We assessed the relationship between Ascaris-specific IgE, respiratory symptoms and allergic sensitization in Bangladesh immigrants. 246 individuals were examined from 1996 to 2001. Serum total IgE, Ascaris IgE, specific IgE to inhalant allergens, skin prick tests (SPT) and parasitological evaluation of the stool were performed. Total serum IgE were significantly higher in Ascaris-IgE positive (> 0.35 kU/L) individuals (806.5 [409.0-1436.0] kU/L vs. 207.0 [127.0-332.5] kU/L; P < 0.0001) and in subjects with respiratory symptoms (413.0 [239.0-1096.0] kU/L vs. 259.5 [147.0-387.0] kU/L), (P < 0.0001), but not in SPT positive subjects (413.0 [179.0-894.0] kU/L vs. 404.6 [305.0-1201.0] kU/L (P = 0.5). Ascaris-specific IgE were detected in 48 subjects with respiratory symptoms (40.0%) and in 46 subjects without respiratory symptoms (36.5%) (P = 0.5). The SPT positivity was similar between Ascaris-IgE seropositive (38.2%) and Ascaris-IgE seronegative (38.1%) subjects (P = 0.9). Total IgE and length of stay in Italy correlated with SPT positivity (OR 5.6 [CI 95% 1.5-19.8], P = 0.007, and OR 1.5 [CI 95% 1.3-1.7], P< 0.0001), and with respiratory symptoms (OR 13.7 [CI 95% 3.0-62.4];, P = 0.0007, and OR 2.4 [CI 95% 1.9-3.0], P < 0.0001). Ascaris-IgE were negatively associated with SPT positivity (OR 0.3 [CI 95% 0.1-0.8], P = 0.02) and with respiratory symptoms (OR 0.1 [CI 95% 0.04-0.7], P = 0.01). Our findings favour the role of environmental factors in the development of respiratory symptoms in immigrants, irrespective of Ascaris-IgE.
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Affiliation(s)
- G Di Lorenzo
- Dipartimento di Medicina Clinica e delle Patologie Emergenti, Università degli Studi di Palermo, Italy.
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Obihara CC, Beyers N, Gie RP, Hoekstra MO, Fincham JE, Marais BJ, Lombard CJ, Dini LA, Kimpen JLL. Respiratory atopic disease, Ascaris-immunoglobulin E and tuberculin testing in urban South African children. Clin Exp Allergy 2006; 36:640-8. [PMID: 16650050 DOI: 10.1111/j.1365-2222.2006.02479.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidemiological relation of intestinal helminth infection and atopic disease, both associated with a T-helper (Th) 2 immune response, is controversial, as it has been reported that helminth infection may either suppress or pre-dispose to atopic disease. This relation has not been tested in an area with a high burden of Mycobacterium tuberculosis (MTB) infection, a known Th1-stimulating infection. OBJECTIVE To study the association of intestinal helminth infection and atopic disease in a community where helminth infection is endemic and MTB infection is high. METHODS Three-hundred and fifty-nine randomly selected children aged 6-14 years from a poor urban suburb were tested with allergy questionnaire, skin prick test (SPT) to common aeroallergens, Ascaris-specific IgE (Ascaris-sIgE), fecal examination for pathogenic intestinal helminths and tuberculin skin testing (TST). Histamine bronchoprovocation was tested in the group of children aged 10 years and older. RESULTS were corrected for demographic variables, socioeconomic status, parental allergy, environmental tobacco smoke (ETS) exposure in the household, recent anthelminthic treatment and for clustering in the sampling unit. Results Ascaris-sIgE was elevated in 48% of children, Ascaris eggs were found in 15% and TST was positive in 53%. Children with elevated Ascaris-sIgE had significantly increased risk of positive SPT to aeroallergens, particularly house dust mite, atopic asthma (ever and recent), atopic rhinitis (ever and recent) and increased atopy-related bronchial hyper-responsiveness. In children with negative TST (<10 mm), elevated Ascaris-sIgE was associated with significantly increased risk of atopic symptoms (adjusted odds ratio (OR(adj)) 6.5; 95% confidence interval (CI) 1.9-22.4), whereas in those with positive TST (>/=10 mm) this association disappeared (OR(adj) 0.96; 95% CI 0.4-2.8). CONCLUSIONS These results suggest that immune response to Ascaris (Ascaris-sIgE) may be a risk factor of atopic disease in populations exposed to mild Ascaris infection and that MTB infection may be protective against this risk, probably by stimulation of anti-inflammatory networks.
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Affiliation(s)
- C C Obihara
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
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Karadag B, Ege M, Bradley JE, Braun-Fahrländer C, Riedler J, Nowak D, von Mutius E. The role of parasitic infections in atopic diseases in rural schoolchildren. Allergy 2006; 61:996-1001. [PMID: 16867054 DOI: 10.1111/j.1398-9995.2006.01107.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing evidence that the farming environment has a protective effect as regards allergic diseases. Exposure to animal parasites, particularly helminth infections, is common in the farming environment. However, the role of helminths in this environment is not well determined to date. METHODS This analysis focuses on 613 children 6-13 years of age from rural areas of Austria, Germany and Switzerland, who took part in the Allergy and Endotoxin (ALEX) study. Allergic diseases and farming characteristics were assessed by a standardized questionnaire and as a crude measure of possible exposure to helminths, IgG antibodies to Ascaris lumbricoides were measured. RESULTS Exposure to nematodes, as determined by the levels of antibody to A. lumbricoides, was more frequent among farmers' children than non-farmers' children (39.8%vs 31.1%, P = 0.03). This positive serology was found to be significantly associated with high total IgE levels [odds ratio (OR) = 3.05, 95% confidence interval (CI) = 1.81-5.12] and eosinophilia (OR = 2.84, 95% CI = 1.66-4.84). However, no association between anti-nematode serology and the prevalences of asthma, wheeze, hay fever or atopy was found. A weak association for atopy was observed after adjustment for total IgE. CONCLUSION Immunoglobulin G antibodies to A. lumbricoides, as a crude measure of possible exposure to helminths, did not indicate any protective effect against allergic diseases in this population. Although farmers' children had increased antibody levels reactive to helminth parasites indicating exposure, this did not explain the protective effect of farming against atopic diseases.
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Affiliation(s)
- B Karadag
- Children's Hospital, University of Munich, Munich, Germany
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