The innate immune system and its role in allergic disorders

Mast cells-fetal mast cells crosstalk with maternal interfaces during pregnancy: Friend or foe?

Mast cells (MC) are hematopoietic immune cells that play a major role during allergic reactions in adults by releasing a myriad of vasoactive and inflammatory mediators. MC seed all vascularized tissues and are most prominent in organs with a barrier function such as skin, lungs, and intestines. These secreted molecules cause mild symptoms such as localized itchiness and sneezing to life-threatening symptoms (i.e., anaphylactic shock). Presently, despite the extensive research on Th2-mediated immune responses in allergic diseases in adults, we are still unable to determine the mechanisms of the role of MC in developing pediatric allergic (PA) disorders. In this review, we will summarize the most recent findings on the origin of MC and discuss the underappreciated contribution of MC in the sensitization phase to maternal antibodies during pregnancy in allergic reactions and other diseases such as infectious diseases. Then, we will lay out potential MC-dependent therapeutic strategies to be considered in future investigations to understand the remaining gaps in MC research for a better quality of life for these young patients.

Maternal immune-related conditions during pregnancy may be a risk factor for neuropsychiatric problems in offspring throughout childhood and adolescence

BACKGROUND

Emerging research suggests that maternal immune activation (MIA) may be associated with an increased risk of adverse neurodevelopmental and mental health outcomes in offspring. Using data from the Raine Study, we investigated whether MIA during pregnancy was associated with increased behavioral and emotional problems in offspring longitudinally across development.

METHODS

Mothers (Generation 1; N = 1905) were classified into the following categories: AAAE (Asthma/Allergy/Atopy/Eczema; N = 1267); infection (during pregnancy; N = 1082); no AAAE or infection (N = 301). The Child Behavior Checklist (CBCL) was administered for offspring at ages 5, 8, 10, 14, and 17. Generalized estimating equations were used to investigate the effect of maternal immune status on CBCL scores.

RESULTS

AAAE conditions were associated with significant increases in CBCL Total (β 2.49; CI 1.98-3.00), Externalizing (β 1.54; CI 1.05-2.03), and Internalizing (β 2.28; CI 1.80-2.76) scores. Infection conditions were also associated with increased Total (β 1.27; CI 0.77-1.78), Externalizing (β 1.18; CI 0.70-1.66), and Internalizing (β 0.76; CI 0.28-1.24) scores. Exposure to more than one AAAE and/or infection condition was associated with a greater elevation in CBCL scores than single exposures in males and females. Females showed greater increases on the Internalizing scale from MIA, while males showed similar increases on both Internalizing and Externalizing scales.

CONCLUSIONS

MIA was associated with increased behavioral and emotional problems in offspring throughout childhood and adolescence. This highlights the need to understand the relationship between MIA, fetal development, and long-term outcomes, with the potential to advance early identification and intervention strategies.

Investigation of Allergic Sensitization Pattern in 4,203 Children in Northern China

OBJECTIVE

The objective of this study is to investigate the allergen sensitization pattern among 4,203 children in the Shanxi region of China and to provide guidance for diagnosis and prevention of allergic diseases.

METHODS

A retrospective analysis was conducted on the allergen-specific immunoglobulin E (sIgE) results of 4,203 children aged 0-12 years from January to December in 2019. SIgE antibodies to 19 allergens in the serum sample were detected by enzyme ALLERGO-SORBENT testing.

RESULTS

In total, 49.70% (2,089/4,203) of children with allergic diseases were positive for sIgE, and the top 5 allergens were egg white 18.63% (783/4,203), artemisia 14.47% (608/4,203), milk 13.04% (548/4,203), ragweed 8.66% (364/4,203), and poplar/willow/elm 8.52% (358/4,203). Significant differences in the positive rate of food allergens and aeroallergens in different ages were found (p < 0.05). 50.98% (1,065/2,089) patients were sensitive to 2 or more allergens. The high sensitization rate in the >3-year group was significantly higher than the ≤3-year group (p < 0.05).

CONCLUSION

Egg white and artemisia are the most common allergens in children in northern China. This study provides allergic sensitization pattern of children and clinical epidemiological data in the region.

Maternal immune conditions are increased in males with autism spectrum disorders and are associated with behavioural and emotional but not cognitive co-morbidity

Epidemiological and animal research shows that maternal immune activation increases the risk of autism spectrum disorders (ASD) in offspring. Emerging evidence suggests that maternal immune conditions may play a role in the phenotypic expression of neurodevelopmental difficulties in children with ASD and this may be moderated by offspring sex. This study aimed to investigate whether maternal immune conditions were associated with increased severity of adverse neurodevelopmental outcomes in children with ASD. Maternal immune conditions were examined as predictors of ASD severity, behavioural and emotional well-being, and cognitive functioning in a cohort of 363 children with ASD (n = 363; 252 males, 111 females; median age 3.07 [interquartile range 2.64-3.36 years]). We also explored whether these outcomes varied between male and female children. Results showed that maternal asthma was the most common immune condition reported in mothers of children with ASD. A history of maternal immune conditions (p = 0.009) was more common in male children with ASD, compared to female children. Maternal immune conditions were associated with increased behavioural and emotional problems in male and female children. By contrast, maternal immune conditions were not associated with decreased cognitive function. The findings demonstrate that MIA may influence the expression of symptoms in children with ASD and outcomes may vary between males and females.

Allergen sensitization pattern of allergic adults and children in southern China: a survey based on real life data

Background

Allergic diseases are increasing yearly. We aimed to evaluate the difference in allergen sensitization pattern between adults and children in southern China by analyzing a large sample size of real-life data, and to provide the evidence for formulating the prevention and management strategies.

Methods

Retrospective analysis was conducted on 39,813 serum allergen-specific IgE (sIgE) results collected in southern China from January to December in 2017. Sensitization patterns and how these allergens could lead to the allergic diseases were analyzed for adults and children respectively. The difference of allergen positive rate between groups was calculated using the Chi square test.

Results

The top five most sensitized allergens in southern China were house dust mite (28.1%), cockroach (24.3%), shrimp (19.2%), crab (15.5%) and egg white (9.9%). While cockroach had the highest positive rate in adults (29.2%), the most sensitized allergen in children was house dust mite (29.7%). The positive rates of egg white and cow’s milk in children were higher than in adults for the whole year (p < 0.001); whereas for adults, the positive rate to cockroach, shrimp and crab were higher than in children (p < 0.001). The positive rate of house dust mite in coastal cities (32.4%) was higher than that in landlocked cities (24.0%) in children, but in adults, the rate in landlocked cities (31.1%) was higher than that in coastal cities (25.3%). Optimal scaling analysis showed that the sIgEs of crab and shrimp had the closest correlation with cockroach-sIgE (Cronbach’s α = 0.891). The positive rate to mold allergens increased from summer to autumn, reaching its plateau in October (6.2%). Patients with skin diseases were found to receive the highest sIgE prescription from doctors (56.9%).

Conclusions

Doctors tend to prescribe more sIgE tests for patients with skin disorders in southern China. In addition to house dust mite, cockroach was found to be another important allergen. Adults with multiple sensitization always showed co-sensitization with shrimp, crab and house dust mite. These should be taken into consideration when giving allergen avoidance advice to patients.

Electronic supplementary material

The online version of this article (10.1186/s13223-019-0357-y) contains supplementary material, which is available to authorized users.

Endotoxin, Toll-like Receptor-4, and Atherosclerotic Heart Disease

Background:

Endotoxin is a lipopolysaccharide (LPS) constituent of the outer membrane of most gram negative bacteria. Ubiquitous in the environment, it has been implicated as a cause or con-tributing factor in several disparate disorders from sepsis to heatstroke and Type II diabetes mellitus. Starting at birth, the innate immune system develops cellular defense mechanisms against environmen-tal microbes that are in part modulated through a series of receptors known as toll-like receptors. Endo-toxin, often referred to as LPS, binds to toll-like receptor 4 (TLR4)/ myeloid differentiation protein 2 (MD2) complexes on various tissues including cells of the innate immune system, smooth muscle and endothelial cells of blood vessels including coronary arteries, and adipose tissue. Entry of LPS into the systemic circulation ultimately leads to intracellular transcription of several inflammatory mediators. The subsequent inflammation has been implicated in the development and progression atherosclerosis and subsequent coronary artery disease and heart failure.

Objective:

The potential roles of endotoxin and TLR4 are reviewed regarding their role in the pathogen-esis of atherosclerotic heart disease.

Conclusion:

Atherosclerosis is initiated by inflammation in arterial endothelial and subendothelial cells, and inflammatory processes are implicated in its progression to clinical heart disease. Endotoxin and TLR4 play a central role in the inflammatory process, and represent potential targets for therapeutic intervention. Therapy with HMG-CoA inhibitors may reduce the expression of TLR4 on monocytes. Other therapeutic interventions targeting TLR4 expression or function may prove beneficial in athero-sclerotic disease prevention and treatment.

Budesonide increases TLR4 and TLR2 expression in Treg lymphocytes of allergic asthmatics

BACKGROUND

Reduced innate immunity responses as well as reduced T regulatory activities characterise bronchial asthma.

OBJECTIVES

In this study the effect of budesonide on the expression of TLR4 and TLR2 in T regulatory lymphocyte sub-population was assessed.

METHODS

TLR4 and TLR2 expression in total peripheral blood mononuclear cells (PBMC), in CD4+/CD25+ and in CD4+/CD25- was evaluated, by flow cytometric analysis, in mild intermittent asthmatics (n = 14) and in controls (n = 11). The in vitro effects of budesonide in modulating: TLR4 and TLR2 expression in controls and in asthmatics; IL-10 expression and cytokine release (IL-6 and TNF-α selected by a multiplex assay) in asthmatics were also explored.

RESULTS

TLR4 and TLR2 were reduced in total PBMC from asthmatics in comparison to PBMC from controls. CD4+CD25+ cells expressed at higher extent TLR2 and TLR4 in comparison to CD4+CD25- cells. Budesonide was able to increase the expression of TLR4, TLR2 and IL-10 in CD4+/CD25 highly+ cells from asthmatics. TLR4 ligand, LPS induced Foxp3 expression. Budesonide was also able to reduce the release of IL-6 and TNF-α by PBMC of asthmatics.

CONCLUSIONS

Budesonide potentiates the activity of Treg by increasing TLR4, TLR2 and IL-10 expression. This event is associated to the decreased release of IL-6 and TNF-α in PBMC treated with budesonide. These findings shed light on new mechanisms by which corticosteroids, drugs widely used for the clinical management of bronchial asthma, control T lymphocyte activation.

The innate response to peanut extract in ovine afferent lymph and its correlation with allergen sensitisation

The innate response generated after initial allergen exposure is crucial for polarising adaptive immunity, but little is known about how it drives an atopic or type-2 immune response. The present study characterises the response of skin-draining afferent lymph in sheep following injection with peanut (PN) extract in the presence or absence of aluminium hydroxide (AlOH) adjuvant. Lymph was collected and innate cell populations characterised over an 84 h time period. The innate response to PN extract in afferent lymph displayed an early increase in neutrophils and monocytes without any changes in the dendritic cell (DC) population. PN antigen was transported by neutrophils and monocytes for the first 36 h, after which time DCs were the major antigen trafficking cells. AlOH adjuvant gradually increased antigen uptake by DCs at the later time points. Following lymphatic characterisation, sheep were sensitised with PN extract by three subcutaneous injections of PN in AlOH, and the level of PN-specific immunoglobulin E (IgE) was determined. Sheep with higher levels of steady-state DCs in afferent lymph showed increased monocytic recruitment in afferent lymph and reduced PN-specific IgE following sensitisation. In addition, DCs from afferent lymph that had ingested PN antigen increased the expression of monocyte chemoattractant mRNA. The results of this study show that the innate response to PN extract involves a dynamic change in cell populations in the afferent lymph over time. In addition, DCs may determine the strength of the initial inflammatory cell response, which in turn may determine the nature of the antigen-specific adaptive response.

A new era of targeting the ancient gatekeepers of the immune system: toll-like agonists in the treatment of allergic rhinitis and asthma

Toll-like receptors (TLR) belong to a large family of pattern recognition receptors known as the ancient 'gatekeepers' of the immune system. TLRs are located at the first line of defense against invading pathogens as well as aeroallergens, making them interesting targets to modulate the natural history of respiratory allergy. Agonists of TLRs have been widely employed in therapeutic or prophylactic preparations useful for asthma/allergic rhinitis (AR) patients. MPL® (a TLR4 agonist) and the CpG oligodeoxynucleotide of 1018 ISS, a TLR9 agonist, show strong immunogenicity effects that make them appropriate adjuvants for allergy vaccines. Targeting the TLRs can enhance the efficacy of specific allergen immunotherapy, currently the only available 'curative' treatment for respiratory allergies. In addition, intranasal administration of AZD8848 (a TLR7 agonist) and VTX-1463 (a TLR8 agonist) as stand-alone therapeutics have revealed efficacy in the relief of the symptoms of AR patients. No anaphylaxis has been so far reported with such compounds targeting TLRs, with the most common adverse effects being transient and local irritation (e.g. redness, swelling and pruritus). Many other compounds that target TLRs have been found to suppress airway inflammation, eosinophilia and airway hyper-responsiveness in various animal models of allergic inflammation. Indeed, in the future a wide variability of TLR agonists and even antagonists that exhibit anti-asthma/AR effects are likely to emerge.

Continuous 6-year follow-up study of sensitization to Japanese cedar pollen and onset in schoolchildren

BACKGROUND

Intra individual longitudinal data has been lacking for IgE-mediated seasonal allergic rhinitis (SAR), especially in young children. Little is known about the development and natural course of SAR in terms of prevalence and incidence rates in schoolchildren.

METHODS

In May or June each year from 1994 to 2007, schoolchildren were assessed for serum Japanese cedar pollen (JCP)-IgE and house dust mite (HDM)-IgE levels, and surveyed regarding nasal symptoms.

RESULTS

Among the 220 children initially assessed in the first grade, 69 (31.4%) were already sensitized to JCP at first grade and 119 (54.1%) did not develop JCP sensitivity during the 6-year study at all. In the first grade children who were HDM-sensitized but JCP non-sensitized, JCP-IgE level was significantly elevated compared to the JCP and HDM non-sensitized group. This seems to indicate that HDM sensitization was very strongly associated with JCP sensitization.

CONCLUSIONS

Elevated serum IgE is a consequence of specific sensitization to HDM and HDM sensitization appeared to develop prior to the start of primary school which distinguishes HDM sensitization from JCP sensitization.

Early life exposure to antibiotics and the risk of childhood allergic diseases: an update from the perspective of the hygiene hypothesis

The prevalence of allergic diseases has been growing rapidly in industrial countries during recent decades. It is postulated that growing up with less microbial exposure may render the immune system susceptible to a T helper type 2 (Th2)-predominant allergic response-also known as the hygiene hypothesis. This review delineates recent epidemiological and experimental evidence for the hygiene hypothesis, and integrates this hypothesis into the association between early life exposure to antibiotics and the development of allergic diseases and asthma. Several retrospective or prospective epidemiological studies reveal that early exposure to antibiotics may be positively associated with the development of allergic diseases and asthma. However, the conclusion is inconsistent. Experimental studies show that antibiotics may induce the Th2-skewed response by suppressing the T helper type 1 (Th1) response through inhibition of Th1 cytokines and disruption of the natural course of infection, or by disturbing the microflora of the gastrointestinal (GI) tract and therefore jeopardizing the establishment of oral tolerance and regulatory T cell immune responses. The hygiene hypothesis may not be the only explanation for the rapid increase in the prevalence of allergic diseases and asthma. Further epidemiological and experimental studies addressing the issue of the impact of environmental factors on the development of allergic diseases and the underlying mechanisms may unveil novel strategies for the prevention and treatment of allergic diseases in the future.

Indoor air contaminants and their impact on respiratory pathologies

Humans spend a considerable amount of their time breathing air inside enclosed spaces in which, due to various sources, there may be contaminants that deteriorate the air quality. This is an important risk factor for the health of the general population. This review evaluates the contaminants that are present in the air of indoor air spaces, describing the sources that generate them as well as the physiopathological mechanisms and the diseases that they may cause in the respiratory system.

Poverty grown up: how childhood socioeconomic status impacts adult health

Socioeconomic status and health status are directly related across the world. Children with low-socioeconomic status not only experience greater health problems in childhood but also aspects of their socioeconomic status become biologically incorporated through both critical periods of development and cumulative effects, leading to poor health outcomes as adults. We explore 3 main influences related to child's socioeconomic status that impact long-term health: the material environment, the social environment, and the structural or community environment. These influences illustrate the importance of clinical innovations, health services research, and public policies that address the socioeconomic determinants of these distal health outcomes.

Does BCG vaccination protect against the development of childhood asthma? A systematic review and meta-analysis of epidemiological studies

BACKGROUND

Results have been conflicting as to whether Bacillus Calmette-Guérin (BCG) vaccine, a non-specific stimulator of the immune function, protects, predisposes or is unrelated to the development of childhood asthma. In this systematic review and meta-analysis, we qualitatively and quantitatively appraised the epidemiological evidence.

METHODS

Eligible studies were identified using a search strategy that included a computerized literature search and a manual search of each article's reference list, up to June 2008. A total of 23 studies were included (10 cohort, 5 case-control and 8 cross-sectional). Each study was summarized and rated for methodological quality. Pooled odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated using fixed-effects (FE) or random-effects (RE) models; if heterogeneity was present, the latter was used. Three indicators of BCG exposure were considered including BCG vaccination, tuberculin response and scar diameter.

RESULTS

The pooled estimate of association for 23 studies reporting on any of the three indicators suggested a protective effect of BCG exposure on childhood asthma occurrence. The studies were heterogeneous, especially when tuberculin response was considered. Restriction to a subgroup of 16 studies that considered BCG vaccination indicated a protective effect with no evidence of heterogeneity. The overall pooled OR using an FE model was 0.86 (95% CI 0.79-0.93). Exclusion of three studies with the lowest quality scores showed a similar association.

CONCLUSION

These results strengthen the epidemiological evidence in support of the hypothesis that exposure to the BCG vaccine in early life prevents asthma, possibly through a modulation of the immune maturation process.

What have we learnt from ISAAC phase III in the Asia-Pacific rim?

PURPOSE OF REVIEW

International Study of Asthma and Allergies in Childhood (ISAAC) phase III had provided a worldwide map of epidemiology of asthma and allergic diseases, as well as the changes in prevalence rate of these diseases when compared to data obtained in phase I. The wide variations of environmental factors and ethnic background in Asia provide excellent opportunities for research into the environmental and genetic determinants of asthma and allergies. This review summarizes important lessons learnt from ISAAC phase III results from Asia on asthma and allergy.

RECENT FINDINGS

ISAAC phase III provided epidemiological evidence of the wide variation and increasing prevalence of asthma and allergy in many Asian countries. When compared to other regions of the world, Asia has a relatively lower prevalence of asthma and allergic diseases. Comparative studies of populations of the same ethnic group living in different environments reveal striking disparity in prevalence of asthma and allergic diseases. The established risk factors could not explain the secular trend and variations of asthma prevalence in different Asian countries. Further research is needed in this rapidly changing region of Asia in order to identify the protective or risk factors associated with the development of asthma.

SUMMARY

ISAAC phase III provides standardized data on the prevalence and burden of asthma and allergy in the Asia-Pacific region. Further research is needed to reveal the underlying factors responsible for the wide variations in disease manifestations in the region.

Influence of Bifidobacterium on gut barrier function and Th1/Th2 cytokine in food allergic mice

AIM: To investigate the effect of the Bifidobacterium on the gut barrier function, intestinal flora and immunologic function in allergic mice.

METHODS: Forty BALB/c mice fed on the OVA-free diet were randomly divided into four groups with ten mice in each group. Mice in A group were sensitized by intraperitoneal injection with SEB+OVA and mice in the other three groups were separately induced with normal saline (NS), SEB or OVA on the 0, 3rd and 9th days; and all of the mice were challenged by means of intragastric gavage with OVA on the 7th and 14th days. Then the natural recovery group, intervention by Bifidobacterium group, intervention by smcta group and intervention by both Bifidobacterium and smcta group were set on the base of SEB+OVA experimental group. From the 15th day after sensitization, all mice were induced with different contents by means of intragastric gavage 7 times, 24 h apart. The intestinal microbial flora was detected by culturing the feces. The serum levels of IgE, IL-4, INF-γ and diamine oxidase (DAO) were analyzed by ELISA. The mesenteric lymph nodes (MLN), homogenated tissues of the livers, kidneys and lungs were cultured to determine for bacterial translocation. The number of CD4⁺CD25⁺ regulatory T cells (CD4⁺CD25⁺ Treg cells) in spleens was measured using flow cytometry.

RESULTS: The levels of IgE(A), DAO(A), IL-4 (51.314 ± 3.785 ng/L vs 69.980 ± 9.103 ng/L, P < 0.05) decreased significantly in Bifidobacterium intervention group compared with those of SEB+OVA group, but the INF-γ increased significantly (194.281 ± 12.144 ng/L vs 133.875 ± 33.822 ng/L, P < 0.05). The number of CD4⁺CD25⁺ Treg cells increased significantly in Bifidobacterium intervention group (5.778% ± 0.773% vs 4.216% ± 0.439%, P < 0.05). The numbers of Lactobacillus and Bifidobacterium in Bifidobacterium intervention group increased significantly compared with those of SEB+OVA group (6.670 ± 0.443 vs 5.654 ± 0.289, 8.611 ± 0.295 vs 7.491 ± 0.339, both P < 0.05). In contrast, the numbers of Escherichia col and Bacteroideae in Bifidobacterium intervention group decreased significantly compared with those of SEB+OVA group (5.364 ± 0.537 vs 6.718 ± 0.267, 7.427 ± 0.544 vs 8.606 ± 0.317, both P < 0.05). The frequency of bacteria translocation of MLNs, livers, kidneys and lungs in Bifidobacterium intervention group decreased significantly compared with that of the SEB+OVA group (12.5% vs 37.5%, P < 0.05).

CONCLUSION: Bifidobacterium could coordinate the immunologic function, cure the alteration of intestinal flora, and protect the intestinal tract mucosa barrier function.

Th2 allergic immune response to inhaled fungal antigens is modulated by TLR-4-independent bacterial products

Allergic airway disease is characterized by eosinophilic inflammation, mucus hypersecretion and increased airway resistance. Fungal antigens are ubiquitous within the environment and are well known triggers of allergic disease. Bacterial products are also frequently encountered within the environment and may alter the immune response to certain antigens. The consequence of simultaneous exposure to bacterial and fungal products on the lung adaptive immune response has not been explored. Here, we show that oropharyngeal aspiration of fungal lysates (Candida albicans, Aspergillus fumigatus) promotes airway eosinophilia, secretion of Th2 cytokines and mucus cell metaplasia. In contrast, oropharyngeal exposure to bacterial lysates (Pseudomonas aeruginosa) promotes airway inflammation characterized by neutrophils, Th1 cytokine secretion and no mucus production. More importantly, administration of bacterial lysates together with fungal lysates deviates the adaptive immune response to a Th1 type associated with neutrophilia and diminished mucus production. The immunomodulatory effect that bacterial lysates have on the response to fungi is TLR4 independent but MyD88 dependent. Thus, different types of microbial products within the airway can alter the host's adaptive immune response and potentially impact the development of allergic airway disease to environmental fungal antigens.

Peanut allergy: an overview

: Peanut allergies have been increasing in prevalence in most industrialized countries. Onset is typically in early childhood, with a trend towards earlier ages of presentation. The allergy is lifelong in most affected children, although 15-22% will outgrow their peanut allergy, usually before their teenage years. Manifestations of peanut allergy range from mild to severe, and risk factors predisposing to severe reactions are discussed. However, even in the absence of risk factors, peanut allergic individuals may still experience life-threatening anaphylactic reactions. Approaches to investigation and treatment, patterns of cross-reactivity and possible causes of rising prevalence are discussed.

Differentiated S100A7 expression in infected tonsils and tonsils from allergic individuals

Palatine tonsils are continuously exposed to microorganisms and antigens and secrete antimicrobial peptides as a first line of defense. S100A7 is a protein with antimicrobial and chemotactic properties. Our aim was to investigate how the expression of S100A7 in human palatine tonsils is affected by inflammatory processes. Tonsils obtained from 109 patients undergoing tonsillectomy were divided into groups of infected and noninfected as well as allergic and nonallergic, based on the results from tonsillar core culture tests and Phadiatop analysis, respectively. Western blot and immunohistochemistry were used to assess protein expression and real-time PCR was used to quantify mRNA levels. To explore the induction of S100A7, tonsils were stimulated with lipopolysaccharide in vitro. The immunohistochemical staining for S100A7 was most intense in the tonsillar epithelium, but the protein was also detected in B- and T-cell regions, which was confirmed with Western blot on isolated B and T cells. The S100A7 expression appeared to be the highest in CD8+ T cells. Reduced mRNA levels of S100A7 were detected in infected tonsils as well as in tonsils from allergic individuals. In vitro stimulation of tonsils with lipopolysaccharide did not have any effect on the expression. The results suggest a role for S100A7 in recurrent tonsillitis and allergic disease.

A 13-year study of Japanese cedar pollinosis in Japanese schoolchildren

BACKGROUND

Japanese cedar pollen (JCP) sensitization and Japanese cedar pollinosis (JCPS) appear to be increasingly prevalent in younger children. The present study investigated factors affecting JCP sensitization and JCPS development in school children.

METHODS

In May or June each year from 1994 to 2006, 275-510 children were assessed for serum JCP-IgE and house dust mite (HDM)-IgE levels, and surveyed regarding rhinoconjunctival symptoms.

RESULTS

Strong JCP sensitization (IgE > or = 17.5 U(A)/ml) was associated with age (odds ratio (OR) = 2.65), the amount of dispersed pollen in the observed year (OR = 2.03) and in the year following birth (OR = 1.51), the month of birth (OR = 2.18), and the recent birth cohort (OR = 1.96). Symptoms were negatively correlated with the recent birth cohort (OR = 0.69) after adjusting for JCP-IgE levels. Strong HDM sensitization was associated with gender (OR = 0.65 for girls) and the recent birth cohort (OR = 1.76).

CONCLUSIONS

JCP sensitization appeared to be associated with the recent birth cohort and to increases in dispersed pollen just after birth and in the observed season. Although the recent birth cohort was more easily sensitized, they were not more likely to develop symptoms. In contrast to JCP sensitization, strong HDM sensitization appeared to develop prior to commencement of primary school and was more likely to affect boys.

Childhood asthma epidemiology: insights from comparative studies of rural and urban populations

Asthma is one of the most common chronic respiratory disorders. Many epidemiology studies have suggested an increasing trend of asthma in many different regions of the world but the exact reasons explaining such trend remain unclear. Nevertheless, changing environmental factors are most likely important in explaining the trend of asthma. Studies in the past decade have clearly shown a mark difference in the prevalence between urban and rural regions. The consistent findings of a markedly lower prevalence of asthma in children and adults who have been brought up in a farming environment clearly indicate the importance of environmental influence of asthma development. Although the exact protective environmental factors in the rural region remain to be defined, there have been many studies suggesting that early exposure to microbes or microbial products may play a role in modulating the immune system so as to reduce the future risk of asthma and allergies. Advances in the understanding of the genetic predisposition and how these genetic factors may interact with specific environment factors are of paramount importance for the future development of primary preventive strategies for asthma.

Acinetobacter lwoffii and Lactococcus lactis strains isolated from farm cowsheds possess strong allergy-protective properties

BACKGROUND

Children who grow up in a farming environment show lower levels of atopic sensitization, hay fever, and asthma than children of the same age not living in such an environment. A number of investigations provided good evidence that this is due to an early-life contact with cowsheds, farm animals, and/or consumption of products like raw milk. Also, it had been indicated that microorganisms might have an important effect on the development of allergies, and thus the question arose of which farm microbial organisms, their products, or both might induce or influence allergy-protective mechanisms.

OBJECTIVE

We sought to gain further insight into the potential allergy-protective properties of microbes isolated from the farming environment.

METHODS

Of a number of bacterial species identified in cowsheds of farms, 2 were selected, isolated, and characterized, namely Acinetobacter lwoffii F78 and Lactococcus lactis G121. The isolates were investigated with regard to their activation of pattern-recognition receptors, the maturation of human monocyte-derived dendritic cells, the upregulation of inflammatory cytokines, the T(H)1-polarizing Notch ligand expression, and their influence on the allergic phenotype.

RESULTS

It is shown that both bacterial isolates were able to reduce allergic reactions in mice, to activate mammalian cells in vitro, and to induce a T(H)1-polarizing program in dendritic cells.

CONCLUSION

Our data strongly support the hygiene hypothesis, which states that an environment rich in microbiologic structures, such as a farming environment, might protect against the development of allergies.

CLINICAL IMPLICATIONS

This work provides the first data on a potential application of cowshed bacteria in allergy protection.

Epidemiological and immunological evidence for the hygiene hypothesis

Allergic diseases are inflammatory disorders that develop on the basis of complex gene-environment interactions. The prevalence of allergies is steadily increasing and seems to be associated with modern lifestyle. Therefore, it was hypothesized that high living standards and hygienic conditions are correlated with an increased risk for the development of an allergic disease. This so-called "hygiene hypothesis" states that due to reduced exposure to microbial components, the proposed allergy-preventing potential of these factors is no more present in sufficient qualities and/or quantities, which leads to an imbalance of the immune system with a predisposition to the development of allergic disorders. Meanwhile, several epidemiological studies were conducted supporting this concept and generating novel ideas for the underlying mechanisms that were then followed up by use of well-defined animal models and human studies. The current view of cellular and molecular mechanisms responsible for these phenomena includes changes in the fine balancing of T helper cell 1 (Th1), Th2 and regulatory T cell (Treg) responses which are triggered by altered or missing innate immune cell activation. In fact, proper activation of cells of the innate immune system via their so-called pattern recognition receptors has been demonstrated to play a crucial role in early shaping of the immune system and suppression of the development of Th2-driven allergic immune responses. These processes start already in utero and prenatal as well as early postnatal developmental stages seem to represent a certain "window of opportunity" for allergy-preventing environmental influences.

Mannan-binding lectin in asthma and allergy

Mannan-binding lectin (MBL) is a vital and versatile component of innate immunity. It is present in serum and may bind to a plethora of microbial pathogens and mediate opsonization of these by complement-dependent and/or independent mechanisms. Low-MBL levels in serum, attributed to certain genetic polymorphisms, constitute a major factor predisposing to several infectious diseases. However, recent studies propose that MBL extends beyond its classic role as a first-line host-defense molecule to a modulator of inflammation. In this review, we summarize and explore this potential and a possible novel role of MBL in asthma and allergy.

Hypoallergenic fragment of Par j 2 increases functional expression of Toll-like receptors in atopic children

BACKGROUND

Parietaria judaica (Par j) is one of the main causes of allergy in the Mediterranean countries. The activation of Toll-like receptor 4 (TLR4) by lipopolysaccharide (LPS) inhibits nasal inflammation of atopic children.

OBJECTIVE

To examine, in vivo and in vitro, the effect of recombinant Par j 2 (rPar j 2) and of its fragments (1-55 and 52-102) on atopic children.

METHODS

We used skin prick test for in vivo evaluations. We assessed, in vitro, in peripheral blood mononuclear cells (PBMC), the effect of rPar j 2 and of the two fragments on neutrophil chemotaxis, on CD45RO, on TLR2 and TLR4 expression, on LPS binding and on interferon (IFN)-gamma release, by a microchemotaxis chamber, by flow cytometry and by enzyme-linked immunosorbent assay, respectively.

RESULTS

In vivo while rPar j 2 induced a positive skin reaction, 1-55 and 52-102 fragments did not. In vitro, while rPar j 2 increased both CD45RO expression and neutrophils chemotaxis in PBMC, both Par j 2 fragments did not. 1-55 fragment of Par j 2 upregulated both TLR2 and TLR4 expression and LPS binding, while the rPar j 2 and 52-102 fragment did not. Finally, 1-55 fragment of Par j 2 induced IFNgamma release, while the rPar j 2 and 52-102 fragment did not.

CONCLUSIONS

Hypoallergenic 1-55 fragment, upregulating innate immunity receptors and increasing IFNgamma, might re-orientate, in atopics, the immune system toward a physiologic balance between Th1 and Th2 responses.

Occupational endotoxin-exposure and possible health effects on humans

BACKGROUND

Endotoxins are commonly found at workplaces where large amounts of bioaerosols are generated. In Germany, especially since the Ordinance on Safety and Health Protection related to work involving biological agents (Biostoff-Verordnung) became effective (1999), threshold limit values are widely discussed. Up to the present, endotoxin values are measured with non-uniform methods and therefore values are of limited benefit for classification of exposure groups. In Germany there is no threshold limit value for endotoxin.

METHODS

Relevant literature of the last 20 years was selected from Medline and discussed.

RESULTS

In this review we focused on the impact of endotoxin exposure on human health with special respect to the measurements on workplace and methodological aspects of endotoxin determination. Methods for sampling and endotoxin determination have to be validated, optimized, and standardized first.

CONCLUSION

The adverse health effects of endotoxins are known, standardization of measurements is a necessary goal and protection measures should be established immediately.

Defect of toll-like receptor 9-mediated activation in NC/Nga mouse macrophages

Toll-like receptors (TLRs) control activation of adaptive immune responses by antigen-presenting cells (APCs). In this study, we examined TLR9-mediated activation in NC/Nga mice, an animal model for human atopic dermatitis. NC/Nga mouse macrophages produced significantly less TNF-alpha than did BALB/c mouse macrophages in response to CpG oligonucleotide (ODN). In addition to defective TLR9-mediated TNF-alpha production, phosphorylation of ERK1,2 and p38 was rapidly diminished after 60 min of CpG ODN stimulation, whereas phosphorylation of these molecules was sustained until 60 min in BALB/c mice. Furthermore, phosphorylation of c-Jun N-terminal kinase (JNK) was not observed in NC/Nga mouse macrophages. In contrast, B cells and dendritic cells (DCs) from NC/Nga mice showed normal responses to CpG ODN stimulation. The expression level of TLR9 in NC/Nga mouse macrophages was significantly lower than that in BALB/c mouse macrophages, whereas levels of TLR9 expression in B cells and DCs in NC/Nga mice were the same as those in BALB/c mice. These results suggest that defective TLR9-mediated activation in NC/Nga mouse macrophages contributes to the reduction of TLR9 expression levels.