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Preda M, Smolinska S, Popescu FD. Diagnostic Workup in IgE-Mediated Allergy to Asteraceae Weed Pollen and Herbal Medicine Products in Europe. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1494. [PMID: 39336535 PMCID: PMC11433692 DOI: 10.3390/medicina60091494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/10/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024]
Abstract
Anemophilous weeds from the Asteraceae family are highly allergenic and represent a significant source of aeroallergens in late summer and autumn. Ragweed and mugwort pollen allergies have become a significant health burden in Europe. Some people with respiratory allergies to weed pollen may also suffer hypersensitivity reactions to herbal medicines obtained from certain cross-reactive plants in the Compositae family, such as chamomile, marigold, and purple coneflower. General physicians, ear, nose, and throat (ENT) specialists, and pulmonologists need to be familiar with the diagnostic tests used by allergists in clinical practice to support accurate diagnosis in such patients. Allergists must also be aware of the suggestions of the European Medicines Agency (EMA)'s Herbal Medicinal Products Committee and the broad spectrum of herbal therapies to educate their patients about potential risks.
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Affiliation(s)
- Mariana Preda
- Faculty of Medicine, Department of Allergology "Nicolae Malaxa" Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, 022441 Bucharest, Romania
| | - Sylwia Smolinska
- Faculty of Medicine, Department of Clinical Immunology, Wroclaw Medical University, 51-616 Wroclaw, Poland
| | - Florin-Dan Popescu
- Faculty of Medicine, Department of Allergology "Nicolae Malaxa" Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, 022441 Bucharest, Romania
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2
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Mühlmeier G, Tisch M. [Immunoglobulin E in nasal secretions]. HNO 2024; 72:633-638. [PMID: 39031180 DOI: 10.1007/s00106-024-01499-8] [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] [Accepted: 06/10/2024] [Indexed: 07/22/2024]
Abstract
Diagnosis of allergic disease is primarily verified by IgE blood serum analysis. Determination in nasal secretions is technically more difficult, particularly due to a low specimen volume and the method of sample collection. Nasal secretions are frequently collected by lavage, which allows qualitative diagnostics, whereas swabs with defined amounts of mucus enable quantitative analyses. In the case of negative skin and serum tests, detection of IgE in nasal mucus combined with nasal provocation testing aids differentiation between local allergic and nonallergic rhinitis.
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Affiliation(s)
- Guido Mühlmeier
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
| | - Matthias Tisch
- Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Mortada MM, Kurowski M. Challenges in Local Allergic Rhinitis Diagnosis, Management, and Research: Current Concepts and Future Perspectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050929. [PMID: 37241161 DOI: 10.3390/medicina59050929] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Local allergic rhinitis (LAR) is diagnosed based on the presence of clinical symptoms such as rhinorrhea, sneezing, and nasal itching using negative skin prick testing and serum IgE assessment. Several novel studies have shown that it is possible to use the assessment of nasal sIgE (specific immunoglobulin E) secretion as an additional diagnostic criterion for local allergic rhinitis. Additionally, allergen immunotherapy is a promising-albeit still not fully assessed and evaluated-future method of managing patients with LAR. In this review, the historical background, epidemiology, and main pathophysiological mechanisms of LAR shall be presented. Additionally, we address the current state of knowledge based on selected articles regarding the assessment of the local mucosal IgE presence in response to exposure to such allergens as mites, pollen, molds, and others. The impact of LAR on quality of life as well as the possible options of management (including allergen immunotherapy (AIT), which showed promising results) will then be presented.
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Affiliation(s)
- Mohamad Mahdi Mortada
- Department of Immunology and Allergy, Medical University of Łódź, 92-213 Łódź, Poland
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Łódź, 92-213 Łódź, Poland
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De Marchi S, Cecchin E, De Marchi SU, Iuri F, Sechi LA. Risk of Chronic Rhinosinusitis With Nasal Polyps in Endotypes of Dermatophagoides pteronyssinus-Induced Rhinitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1506-1514.e2. [PMID: 35074602 DOI: 10.1016/j.jaip.2022.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Observation of the natural history of two emerging endotypes of allergic rhinitis, local-sensitization rhinitis (LAR) and dual-allergic rhinitis (DAR), compared with systemic-sensitization rhinitis (AR), could improve knowledge of the role of allergy in chronic rhinosinusitis with nasal polyps (CRSwNP). OBJECTIVE To test the hypothesis that endotypes of Dermatophagoides pteronyssinus (DP)-induced rhinitis were risk factors for CRSwNP and adult-onset asthma and to investigate whether delayed hypersensitivity to DP, assessed by atopy patch test, could be a contributing factor. METHODS We conducted a prospective observational study over 15 years on a cohort of 999 patients: 468 with AR, 333 with LAR, and 198 with DAR. The latter endotype was characterized by the coexistence of seasonal disease caused by systemic sensitization to pollen in patients with DP-induced LAR. The study design included a physical visit; ear, nose, and throat examination with anterior rhinoscopy; skin prick test; serum-specific IgE; DP-atopy patch test; nasal allergen provocation test with DP; paranasal sinuses computed tomography scan; nasal endoscopy; and spirometry. RESULTS During 15 years of follow-up, 194 patients developed CRSwNP with a higher rate of LAR (28.2%) and DAR (22.2%) than AR (12%). For LAR and DAR, 7.5% and 10.6% of patients developed adult-onset asthma temporally linked to CRSwNP in 68% and 71.4% of cases, respectively. A total of 858 patients with rhinitis had delayed hypersensitivity to DP. Moreover, DP-ATP was an independent predictive factor for CRSwNP and had elevated positive and negative predictive values for localized allergic disease of the nasal mucosa. CONCLUSIONS Endotypes of DP-induced allergic rhinitis represent risk factors for CRSwNP. Patients with local-sensitization rhinitis and DAR are more at risk than those with AR. In these emerging endotypes, progression toward CRSwNP is often associated with the development of adult-onset asthma. Chronic rhinosinusitis with nasal polyps shows several possible indicators for type 2 endotype. Delayed hypersensitivity to DP is an independent predictive factor for CRSwNP.
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Affiliation(s)
- Sergio De Marchi
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy.
| | - Emanuela Cecchin
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
| | | | - Federico Iuri
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
| | - Leonardo A Sechi
- Department of Medicine, University of Udine, School of Medicine, Udine, Italy
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5
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Krzych-Fałta E, Furmańczyk K, Dziewa-Dawidczyk D, Wojas O, Retlewska K, Samoliński BK. The role of the nasal allergen provocation test in local allergic rhinitis cases: a preliminary report. Postepy Dermatol Alergol 2020; 37:890-897. [PMID: 33603605 PMCID: PMC7874866 DOI: 10.5114/ada.2019.84719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 04/05/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The current state of knowledge is that allergic rhinitis can occur in two forms. One is allergic rhinitis as a manifestation of a systemic allergy with systemic atopy and positive results of skin prick tests or sIgE tests. The other is local allergic rhinitis (LAR) as a local allergic reaction affecting only the nasal mucosa without systemic atopy. AIM To attempt to assess the usefulness of the nasal allergen provocation test for the purposes of differential diagnosis and the qualification of LAR patients for therapy. MATERIAL AND METHODS The subjects in the study were a group of 6 adults diagnosed with LAR on the basis of their medical history and the results of nasal allergen provocation tests, with the allergens being house dust mites (Dermatophagoides pteronyssinus, Dermatophagoides farinae). The methods adopted in the study were a point-based rating scale as a measure of nasal/extranasal complaints and active anterior rhinomanometry. RESULTS Significant differences (p < 0.05) were observed, using the subjective rating scale, in relation to registered nasal and extranasal complaints in the early phase of the allergic reaction. Similarly, the rhinomanometry method revealed significant differences in nasal resistance values before and after the administration of an allergen. CONCLUSIONS The nasal allergen provocation test is the only testing tool that objectively measures the degree of the patient's allergic reactions and is useful in qualifying LAR patients for further therapy.
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Affiliation(s)
- Edyta Krzych-Fałta
- Unit of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Furmańczyk
- Unit of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
- Chair of Applied Mathematics, Faculty of Applied Informatics and Mathematics, Warsaw University of Life Sciences, Warsaw, Poland
| | - Diana Dziewa-Dawidczyk
- Chair of Applied Mathematics, Faculty of Applied Informatics and Mathematics, Warsaw University of Life Sciences, Warsaw, Poland
| | - Oksana Wojas
- Unit of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Retlewska
- Unit of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Bolesław K. Samoliński
- Unit of Environmental Hazard Prevention and Allergology, Medical University of Warsaw, Warsaw, Poland
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Eguiluz-Gracia I, Ariza A, Testera-Montes A, Rondón C, Campo P. Allergen Immunotherapy for Local Respiratory Allergy. Curr Allergy Asthma Rep 2020; 20:23. [PMID: 32430550 DOI: 10.1007/s11882-020-00920-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIESW Local respiratory allergy (LRA) is an eosinophilic phenotype of chronic airway disease. Three entities have been described within the LRA spectrum: local allergic rhinitis (LAR) and local allergic asthma (LAA) in non-atopic patients, and dual allergic rhinitis (DAR) in atopic patients (coexistence of LAR and allergic rhinitis). In this article, we aim to review the current evidence on the therapeutic options for LRA. RECENT FINDINGS No controlled study has assessed the effect of standard therapy (oral antihistamines, intranasal or inhaled corticosteroids, bronchodilators) in LRA subjects. Three randomized clinical trials and one observational study demonstrated that allergen immunotherapy (AIT) is able to control nasal and ocular symptoms, decrease the need for rescue medication, and improve quality of life in LAR individuals. Nasal or inhaled steroids can be expected to improve eosinophilic inflammation in LRA patients but cannot change the natural course of the disease. Moreover, the long-term and disease-modifying effects of AIT in LRA subjects need to be investigated.
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Affiliation(s)
- I Eguiluz-Gracia
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - A Ariza
- Allergy Research Group, Instituto de Investigacion Biomedica de Malaga-IBIMA and ARADyAL, Málaga, Spain
| | - A Testera-Montes
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - C Rondón
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain.
| | - P Campo
- Allergy Department, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
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How to Diagnose and Treat Local Allergic Rhinitis: A Challenge for Clinicians. J Clin Med 2019; 8:jcm8071062. [PMID: 31331047 PMCID: PMC6678883 DOI: 10.3390/jcm8071062] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/10/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic rhinitis is a very common disease that can be divided in various phenotypes. Historically, the condition has been classified into the allergic rhinitis (AR) and non-allergic non-infectious rhinitis (NAR) forms, based on the results of the classical biomarkers of atopy: skin prick test and serum allergen-specific IgE However, this classification does not reflect the complexity of the rhinitis syndrome, as illustrated by the existence of non-atopic rhinitis patients who display a nasal reactivity to environmental allergens. This new phenotype has been termed local allergic rhinitis (LAR) and can be only recognized if an additional test such as the nasal allergen challenge (NAC) is integrated in the diagnostic algorithm for chronic rhinitis. Recent data shows that the NAC is a very safe and reliable technique ready for the clinical practice. LAR is a differentiated rhinitis phenotype which often commences during childhood and quickly progresses towards a clinical worsening and the association of comorbidities in other mucosal organs. Recent evidence supports the existence of a bronchial counterpart of LAR (local allergic asthma), which highlights the pathophysiological links between the upper and lower airways and reinforces the united airways concept. Importantly, several controlled studies have demonstrated the ability of allergen immunotherapy to control LAR symptoms while the therapy is being administered. This review emphasizes the need to implement the NAC in the clinical practice in order to facilitate the recognition of LAR patients, allowing for an early prescription of specific therapies with disease-modifying potential.
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Yamana Y, Fukuda K, Ko R, Uchio E. Local allergic conjunctivitis: a phenotype of allergic conjunctivitis. Int Ophthalmol 2019; 39:2539-2544. [PMID: 31093805 DOI: 10.1007/s10792-019-01101-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/01/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Local allergic rhinitis (LAR) has been reported in the field of otolaryngology; however, the concept of local allergic conjunctivitis (LAC) has not been widely studied in the ophthalmologic community. We routinely examined total IgE levels in tear fluids (t-tIgE) and antigen-specific IgE levels in serum (s-sIgE) in patients with suspected allergic conjunctivitis, on the basis of Japanese guidelines for allergic conjunctival diseases. There are several cases in which the results of t-tIgE and s-sIgE testing are divergent. We suggest that these divergent cases correspond to LAR in otolaryngology. METHODS The study included 148 patients (33 men and 115 women) with clinical symptoms and signs of allergic conjunctivitis. Allerwatch Tear IgE® was used for measurement of t-tIgE levels. ImmunoCAP Rapid® and View Allergy 39® were used for measurement of s-sIgE levels. Conjunctival cytology using spatula was used to identify eosinophils on the conjunctiva. RESULTS A total of 83 patients (56.1%) were positive and 65 patients were negative for t-tIgE in the AW. In the ICR, 97 patients (65.5%) were positive for at least one of the eight allergens, whereas 51 (34.5%) were negative for all allergens. Among 83 patients positive for t-tIgE, 14 (16.9%) had no detectable s-sIgE. Therefore, we considered the possibility of LAC in cases in which only local IgE could be detected. Among 28 cases (18.9%) who were negative for t-tIgE and s-sIgE, 21 underwent conjunctival scraping; eosinophils were found in four cases and eosinophilic granules in two. Accordingly, we considered the possibility of non-IgE-type AC in these six cases. CONCLUSIONS These results suggest the existence of LAC that is a candidate of a phenotype of AC.
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Affiliation(s)
- Yasuo Yamana
- Yamana Eye Clinic, 13-5, Nabeyama, Nakama, Fukuoka, 809-0022, Japan.
| | - Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi, Japan
| | - Ryota Ko
- Department of Ophthalmology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Eiichi Uchio
- Department of Ophthalmology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Hamed A, Preston DC, Eschenbacher W, Khokhar D, Workman L, Steinke JW, Heymann P, Lawrence M, Soto-Quiros M, Platts-Mills TAE, Payne S, Borish L. Nasal IgE production in allergic rhinitis: Impact of rhinovirus infection. Clin Exp Allergy 2019; 49:847-852. [PMID: 30776162 DOI: 10.1111/cea.13372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/18/2019] [Accepted: 02/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Rhinovirus (RV) infections exacerbate asthma in part by enhancing an allergic state, and these exacerbations can be mitigated via administration of anti-IgE. OBJECTIVE We investigated the presence of local IgE production in the nose of allergic and non-allergic subjects and assessed whether this was enhanced by RV. METHODS Local production of specific IgE was determined by comparing ratios of specific to total IgE concentrations between nasal and serum samples. Our initial studies were performed in subjects presenting to the emergency department for allergic and non-allergic respiratory complaints. Subsequently, we investigated influences of experimental RV infection on nasal sIgE production in an allergic cohort. RESULTS We found evidence of local sIgE production to Dermatophagoides pteronyssinus in 30.3% and to Blomia tropicalis in 14.6% of allergic subjects. None of the non-allergic subjects demonstrated local IgE. Subjects with active RV infection were more than twice as likely to have local sIgE (45% vs 14%), and subjects with local sIgE being produced were ~3 times more likely to be having an asthma exacerbation. Experimental RV infection was able to induce local sIgE production. CONCLUSION These studies confirm local IgE production in a large subset of allergic subjects and demonstrate that allergic asthmatics with local IgE are more likely to develop an asthma exacerbation when infected with RV. Our RV challenge studies demonstrate that at least some allergic asthmatics can be induced to secrete locally generated IgE in their nasal airway after RV infection.
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Affiliation(s)
- Ahmed Hamed
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - DeVon C Preston
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Will Eschenbacher
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Dilawar Khokhar
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Lisa Workman
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - Peter Heymann
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia
| | - Monica Lawrence
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
| | | | - Thomas A E Platts-Mills
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia
| | - Spencer Payne
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Otolaryngology, University of Virginia Health System, Charlottesville, Virginia
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.,Department of Microbiology, University of Virginia Health System, Charlottesville, Virginia
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Hamizan AW, Rimmer J, Alvarado R, Sewell WA, Tatersall J, Barham HP, Kalish L, Harvey RJ. Turbinate-Specific IgE in Normal and Rhinitic Patients. Am J Rhinol Allergy 2019; 33:178-183. [PMID: 30656948 DOI: 10.1177/1945892418825224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Specific immunoglobulin E (sIgE) within the nasal airway is likely to be the most ideal marker of allergic status, but little is known of the normative values in asymptomatic patients and those with rhinitis. OBJECTIVE The aim of this study was to assess the diagnostic characteristics of inferior turbinate tissue biopsy sIgE in asymptomatic and rhinitic patients. METHODS A diagnostic cross-sectional study was undertaken, involving patients who underwent inferior turbinate surgery with or without other surgical interventions. Inferior turbinate tissue biopsy was performed during surgery and was assessed for allergen sIgE (dust mite, grass [temperate or subtropical], and animal epithelium) using an automated immunoassay. Tissue sIgE was assessed among asymptomatic patients and those with nasal symptoms. Data were presented as median (interquartile range). A receiver operating curve was used to predict the diagnostic utility of turbinate tissue sIgE in determining allergic rhinitis. RESULTS A total of 160 patients (41.89 ± 14.65 years, 36.9% females) were included. The median tissue sIgE concentration among the asymptomatic nonatopic group of patients was 0.09 (0.08-0.10) kUA/L and tissue sIgE > 0.10 kUA/L was determined as a positive threshold. Inferior turbinate tissue sIgE was shown to be a predictive test for allergic rhinitis (area under curve: 0.87, 95% confidence interval: 0.84-0.90) with 90% sensitivity and 89% negative predictive value. CONCLUSION Inferior turbinate tissue biopsy sIgE is a sensitive tool to predict allergic rhinitis. The threshold value of 0.1 kUA/L corresponded well with the asymptomatic nonatopic group of patients. This method detects sIgE in the nasal mucosa and may be a useful test for allergic rhinitis in future research.
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Affiliation(s)
- Aneeza W Hamizan
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,2 Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Janet Rimmer
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,3 Upper Airway Research Group, Woolcock Institute, University of Sydney, Australia.,4 Faculty of Medicine, Notre Dame University, Sydney, Australia.,5 Sydney Medical School, University of Sydney, Sydney, Australia
| | - Raquel Alvarado
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - William A Sewell
- 6 St Vincent's Clinical School, University of New South Wales Sydney, Sydney, Australia.,7 Immunology Division, Garvan Institute, Sydney, Australia
| | - Jessica Tatersall
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia
| | - Henry P Barham
- 8 Sinus and Nasal Specialists of Louisiana, Baton Rouge, Louisiana
| | - Larry Kalish
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,5 Sydney Medical School, University of Sydney, Sydney, Australia.,9 Department of Otolaryngology, Head and Neck Surgery, Concord General Hospital, University of Sydney, Australia
| | - Richard J Harvey
- 1 Rhinology and Skull Base Research Group, St Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, Australia.,10 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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11
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Dilemmas associated with local allergic rhinitis. Postepy Dermatol Alergol 2018; 35:243-245. [PMID: 30008640 PMCID: PMC6041707 DOI: 10.5114/ada.2018.76215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/13/2017] [Indexed: 01/31/2023] Open
Abstract
Local allergic rhinitis (LAR) in patients with no systemic markers of atopy is a very interesting phenomenon due to the lack of any definitive explanation for the mechanism of this IgE-dependent reaction. Some of the recent attempts to explain this phenomenon consider LAR to be closely associated with an allergic reaction, some suggest that this phenomenon is a spontaneous process in the nasal mucosa. Future attempts to elucidate the complexity of inflammatory reactions will undoubtedly establish a clear differential diagnostics algorithm for rhinitis.
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12
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Saricilar EC, Hamizan A, Alvarado R, Rimmer J, Sewell W, Tatersall J, Barham HP, Harvey R. Optimizing Protein Harvest From Nasal Brushings for Determining Local Allergy Responses. Am J Rhinol Allergy 2018; 32:244-251. [PMID: 29785855 DOI: 10.1177/1945892418777668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Rhinitis is a highly prevalent yet often misdiagnosed condition. Patients who have local allergic rhinitis are regularly mislabeled as having a nonallergic etiology. Thus, a highly accurate, reproducible, and noninvasive assessment, which can be performed quickly and with minimal discomfort to the patient, is required. Objective The aim of this research was to identify the efficiency of various nasal brushes as tools for harvest and collection of epithelial proteins and its suitability for identification of rhinitis. Methods Nasal epithelial mucosa samples were taken from patients undergoing turbinate surgery using a cytology brush, a dental brush, and a nasal curette in random order. After washing in phosphate-buffered saline, the suspended cells were sonicated. Total protein content was assessed for all samples by bicinchoninic acid assay measured using a Nanodrop machine. Identification of nasal-specific immunoglobulin E (spIgE) was then assessed using immunoassay and compared to the patient's allergic status from epicutaneous and serum testing. The lower threshold limit for the spIgE in nasal brushings was determined using the results of serum spIgE tests as the reference. The diagnostic accuracy of this new established cutoff value was determined. Results The cytology brush was found to be the optimal tool for maximal nasal mucosa protein collection followed by dental brush and nasal curette (0.75 ± 0.45 mg/mL vs 0.43 ± 0.24 mg/mL vs 0.071 ± 0.55 mg/mL, respectively; P < .01). The optimal cutoff value of nasal spIgE from the cytology nasal brushings was 0.14 kUA/L to predict allergic status from serum testing. This gave a sensitivity of 75%, specificity of 86%, positive predictive value of 74%, likelihood ration positive of 5.40, and diagnostic odds ratio of 18.62. Conclusion The cytology brush is the optimal tool for protein collection. This is an easy and direct method to sample the nasal mucosa for assessment of nasal allergy or future biomarkers.
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Affiliation(s)
- Erin C Saricilar
- 1 Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Aneeza Hamizan
- 1 Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,2 Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Raquel Alvarado
- 1 Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet Rimmer
- 1 Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,3 Upper Airway Research Group, Woolcock Institute, University of Sydney, Sydney, New South Wales, Australia.,4 Faculty of Medicine, Notre Dame University, Darlinghurst, New South Wales, Australia
| | - William Sewell
- 5 St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,6 Immunology Division, Garvan Institute, Sydney, New South Wales, Australia
| | - Jessica Tatersall
- 1 Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Henry P Barham
- 7 Sinus and Nasal Specialists of Louisiana, Baton Rouge, Louisiana
| | - Richard Harvey
- 1 Rhinology and Skull Base Research Group, St. Vincent's Centre for Applied Medical Research, University of New South Wales, Sydney, New South Wales, Australia.,8 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Pepper AN, Ledford DK. Nasal and ocular challenges. J Allergy Clin Immunol 2018; 141:1570-1577. [PMID: 29501480 DOI: 10.1016/j.jaci.2017.11.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/09/2017] [Accepted: 11/21/2017] [Indexed: 12/29/2022]
Abstract
Nasal and ocular challenges facilitate the evaluation of subjective and objective responses to defined allergen or irritant exposure. Nasal and ocular allergen challenges are the gold standard to diagnose allergic rhinitis and conjunctivitis, respectively, and aid in the evaluation of novel therapies in clinical trials. Additionally, nasal and ocular allergen challenges might help identify medically relevant allergens in clinical practice. Nonspecific or irritant challenges evaluate mucosal hyperreactivity. Direct mucosal challenges, which can be performed in an office or research setting, expose the participant to higher allergen doses than common in the natural environment. Park studies and environmental chambers, which are most practical in clinical trials, more closely simulate natural allergen exposure. International consensus guidelines for nasal and ocular challenges do not exist. Therefore the positivity criteria, methodologies, and extract or allergen preparations used in challenges vary in the literature. Regardless of these limitations, nasal and ocular challenges are helpful clinical and research tools for nasal and ocular diseases.
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Affiliation(s)
- Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Affairs Hospital, Tampa, Fla
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Affairs Hospital, Tampa, Fla.
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Eosinophils from Physiology to Disease: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9095275. [PMID: 29619379 PMCID: PMC5829361 DOI: 10.1155/2018/9095275] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/27/2017] [Indexed: 12/26/2022]
Abstract
Despite being the second least represented granulocyte subpopulation in the circulating blood, eosinophils are receiving a growing interest from the scientific community, due to their complex pathophysiological role in a broad range of local and systemic inflammatory diseases as well as in cancer and thrombosis. Eosinophils are crucial for the control of parasitic infections, but increasing evidence suggests that they are also involved in vital defensive tasks against bacterial and viral pathogens including HIV. On the other side of the coin, eosinophil potential to provide a strong defensive response against invading microbes through the release of a large array of compounds can prove toxic to the host tissues and dysregulate haemostasis. Increasing knowledge of eosinophil biological behaviour is leading to major changes in established paradigms for the classification and diagnosis of several allergic and autoimmune diseases and has paved the way to a "golden age" of eosinophil-targeted agents. In this review, we provide a comprehensive update on the pathophysiological role of eosinophils in host defence, inflammation, and cancer and discuss potential clinical implications in light of recent therapeutic advances.
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Incorvaia C, Fuiano N, Martignago I, Gritti BL, Ridolo E. Local allergic rhinitis: evolution of concepts. Clin Transl Allergy 2017; 7:38. [PMID: 29118971 PMCID: PMC5669011 DOI: 10.1186/s13601-017-0174-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/21/2017] [Indexed: 01/12/2023] Open
Abstract
The discovery of an exclusive local production of IgE antibodies dates back to the 1970s, but only recently the pathophysiology of such phenomenon was deeply investigated, leading to the concept of local allergic rhinitis (LAR). Currently, LAR is defined by the occurrence, in patients with symptoms clearly suggesting allergic rhinitis but with negative results to common allergy testing, of allergen specific IgE in the nasal mucosa. Most studies investigating LAR were based on the development of rhinitis symptoms following nasal provocation test (NPT) with the suspected allergens, but such test may be performed by a number of options, none of them being as yet acknowledged and recommended in consensus document. On the other hand, also the mere detection of IgE in the nasal mucosa indicates, as for IgE measurement in blood or other tissues, allergic sensitization but cannot give the certainty of clinical allergy. Therefore, the combination of IgE detection in nasal mucosa and a positive result of NPT should be used to diagnose LAR. Recent data on the use for in vitro testing of molecular allergy diagnostics in place of whole allergen extracts suggest that this method could improve the sensitivity and specificity of laboratory tests, and an appraisal of the basophil activation test as a third level technique, to be implemented when the results of local IgE testing and NPT are uncertain, is currently ongoing.
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Affiliation(s)
| | - Nicola Fuiano
- Pediatric Immunology and Allergy Service, San Severo, Italy
| | - Irene Martignago
- Medicine and Surgery Department, University of Parma, Via Gramsci 14, 43100 Parma, Italy
| | - Bruna L Gritti
- Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy
| | - Erminia Ridolo
- Medicine and Surgery Department, University of Parma, Via Gramsci 14, 43100 Parma, Italy
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Türk M, Bahçecioğlu SN, Yılmaz İ. Is nonhomogeneous expression of tissue mast cells or allergen specific IgEs bound to tissue mast cells possible? Asia Pac Allergy 2017; 7:179-181. [PMID: 28765824 PMCID: PMC5537084 DOI: 10.5415/apallergy.2017.7.3.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022] Open
Abstract
Skin prick tests (SPTs) are widely used to demonstrate an IgE-mediated hypersensitivity reaction to a specific allergen. However, local allergic conditions cannot be diagnosed with SPTs. Local specific IgE production was only presented before in mucosal tissues. We present a patient with house dust mite sensitization that had variable SPTs results in different body regions.
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Affiliation(s)
- Murat Türk
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, 38030 Kayseri, Turkey
| | - Sakine Nazik Bahçecioğlu
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, 38030 Kayseri, Turkey
| | - İnsu Yılmaz
- Division of Allergy and Clinical Immunology, Department of Chest Diseases, Erciyes University School of Medicine, 38030 Kayseri, Turkey
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