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Inuo C, Ando H, Tanaka K, Nakajima Y, Tsuge I, Urisu A, Kondo Y. Decreased Basophil Activation against House Dust Mite after Japanese Cedar Pollen Subcutaneous Immunotherapy: A Retrospective Study. Int Arch Allergy Immunol 2023; 185:73-78. [PMID: 37852197 PMCID: PMC10794963 DOI: 10.1159/000533724] [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: 05/11/2023] [Accepted: 08/18/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Allergen-specific immunotherapy (AIT), an established treatment for allergic diseases, prevents the development of other allergic manifestations. Although the mechanisms remain unclear, AIT has been shown to reduce basophil activation (BA) against nontarget allergens. OBJECTIVES The aim of this study was to assess immunological changes in Dermatophagoides farinae (Der f) after Japanese cedar pollen (JCP)-based subcutaneous immunotherapy (SCIT) monotherapy. METHOD The data of 16 patients (age: 6-37 years) with JCP-induced allergic rhinitis who were sensitive to Der f (serum Der f-specific immunoglobulin E [IgE] level >0.34 kUA/L) and received JCP-based SCIT for 5 years were reviewed retrospectively. BA by Der f and JCP extracts and serum-specific IgE and immunoglobulin G4 (IgG4) levels against these allergens were evaluated before and after completing 5 years of JCP-based SCIT monotherapy. RESULTS The areas under the dose-response curves of BA by Der f and JCP extracts were significantly reduced (p = 0.02 and p = 0.002, respectively). JCP-specific IgE levels decreased and JCP-specific IgG4 levels increased significantly (p < 0.001 for both), whereas Der f-specific IgE and IgG4 levels did not change significantly. CONCLUSIONS JCP-based SCIT monotherapy reduced Der f-specific BA. These findings suggest that JCP-based SCIT has the potential to modulate immune response toward nontarget allergens.
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Affiliation(s)
- Chisato Inuo
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
- Department of Pediatrics, Fujita Health University Bantane Hospital, Nagoya, Japan
- Department of Allergy, Kanagawa Children’s Medical Centre, Yokohama, Japan
| | - Hitoshi Ando
- Department of Pediatrics, Toyokawa City Hospital, Toyokawa, Japan
| | - Kenichi Tanaka
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Yoichi Nakajima
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Ikuya Tsuge
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Atsuo Urisu
- Department of Pediatrics, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Yasuto Kondo
- Department of Pediatrics, Fujita Health University Bantane Hospital, Nagoya, Japan
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2
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Rodríguez-Vázquez V, López-Freire S, Méndez-Brea P, González-Fernández MT, Hernández-Pérez C, Vidal C. [Basophil activation test to follow-up of patients treated with hymenoptera venom immunotherapy: a review of current evidence]. REVISTA ALERGIA MÉXICO 2023; 69:125-137. [PMID: 36869012 DOI: 10.29262/ram.v69i3.1135] [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: 06/13/2022] [Accepted: 10/22/2022] [Indexed: 02/05/2023] Open
Abstract
Hymenoptera venom immunotherapy (HVI) is a long-term effective treatment to avoid new systemic reactions in patients with Hymenoptera allergy. The sting challenge test is considered the gold standard to confirm the tolerance. However, the use of this technique is not generalized in clinical practice, being the basophil activation test (BAT), which functionally explores allergen response, an alternative that does not entail any of the provocation risks associated with the sting challenge test. This study reviews the publications that used the BAT to follow up and evaluate the success of the HVI. Studies assessing the changes between a baseline BAT before the start and BATs performed between the starting and maintenance phases of the HVI were selected. Ten articles were found, comprising information from 167 patients, of which 29% used the sting challenge test. The studies concluded the importance of evaluating the responses with submaximal allergen concentrations, which reflect basophil sensitivity, to monitor the HVI using the BAT. It was also observed that changes in the maximum response (reactivity) could not reflect the clinical status of tolerance, particularly in the initial phases of HVI.
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Affiliation(s)
- Virginia Rodríguez-Vázquez
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.
| | - Sara López-Freire
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Paula Méndez-Brea
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | | | | | - Carmen Vidal
- Servicio de Alergología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.,Facultad de Medicina, Universidad de Santiago de Compostela, España
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Verträglichkeit, Verlauf und Nachsorge der allergenspezifischen Immuntherapie nach einem modifizierten Ultra-Rush-Verfahren bei Kindern und Jugendlichen mit einer Insektengiftallergie. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-021-4939-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hymenoptera Venom Immunotherapy: Immune Mechanisms of Induced Protection and Tolerance. Cells 2021; 10:cells10071575. [PMID: 34206562 PMCID: PMC8306808 DOI: 10.3390/cells10071575] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/03/2023] Open
Abstract
Hymenoptera venom allergy is one of the most severe allergic diseases, with a considerable prevalence of anaphylactic reaction, making it potentially lethal. In this review, we provide an overview of the current knowledge and recent findings in understanding induced immune mechanisms during different phases of venom immunotherapy. We focus on protection mechanisms that occur early, during the build-up phase, and on the immune tolerance, which occurs later, during and after Hymenoptera venom immunotherapy. The short-term protection seems to be established by the early desensitization of mast cells and basophils, which plays a crucial role in preventing anaphylaxis during the build-up phase of treatment. The early generation of blocking IgG antibodies seems to be one of the main reasons for the lower activation of effector cells. Long-term tolerance is reached after at least three years of venom immunotherapy. A decrease in basophil responsiveness correlates with tolerated sting challenge. Furthermore, the persistent decline in IgE levels and, by monitoring the cytokine profiles, a shift from a Th2 to Th1 immune response, can be observed. In addition, the generation of regulatory T and B cells has proven to be essential for inducing allergen tolerance. Most studies on the mechanisms and effectiveness data have been obtained during venom immunotherapy (VIT). Despite the high success rate of VIT, allergen tolerance may not persist for a prolonged time. There is not much known about immune mechanisms that assure long-term tolerance post-therapy.
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Kopač P, Custovic A, Zidarn M, Šilar M, Šelb J, Bajrović N, Eržen R, Košnik M, Korošec P. Biomarkers of the Severity of Honeybee Sting Reactions and the Severity and Threshold of Systemic Adverse Events During Immunotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3157-3163.e5. [PMID: 33962066 DOI: 10.1016/j.jaip.2021.04.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/15/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND A biomarker that could identify individuals at high risk for severe honeybee sting allergic reaction and/or systemic adverse events (SAEs) during venom immunotherapy (VIT) would improve the management of patients with honeybee (HB) venom allergy. OBJECTIVE To identify biomarkers for risk of severe sting reactions or SAEs during VIT. METHODS We recruited 332 patients undergoing HB VIT. We ascertained predictors of the severity of the field-sting reaction and the severity and threshold of SAEs during VIT. We assessed the use of cardiovascular medications; baseline serum tryptase (BST) levels; specific IgEs to HB venom, rApi m 1, and rApi m 10; and basophil activation test (BAT) response. RESULTS Significant and independent predictors of a severe HB field-sting reaction were age (P = .008), an absence of skin symptoms (P = .001), BST (P = .014), and BAT response at an HB venom concentration of 0.1 μg/mL (P = .001). Predictors of severe SAEs during HB VIT were age (P = .025), BST (P = .006), and BAT response (P = .001). BAT response was also an individual and significant predictor of any SAEs and SAEs at a low cumulative allergen dose (median, 55 μg) during VIT build-up (P < .001). The use of β-blockers and angiotensin-converting-enzyme inhibitors and specific IgE levels were not associated with the severity of HB field-sting reactions or VIT SAEs. CONCLUSIONS BST and basophil activation are independent risk factors for severe HB sting anaphylaxis and SAEs during HB VIT. BAT response was the best biomarker for any SAEs and a lower threshold of SAEs during HB VIT. These risk factors can help guide recommendations for VIT and overcome systemic reactions to HB VIT.
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Affiliation(s)
- Peter Kopač
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mihaela Zidarn
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mira Šilar
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Julij Šelb
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Nissera Bajrović
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Renato Eržen
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Mitja Košnik
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Korošec
- University Hospital of Respiratory and Allergic Diseases, Golnik, Slovenia
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Gruzelle V, Mailhol C, Waters DW, Guilleminault L. Clinical Utility of Rush Venom Immunotherapy: Current Status. J Asthma Allergy 2020; 13:1-10. [PMID: 32021308 PMCID: PMC6954838 DOI: 10.2147/jaa.s200917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/03/2019] [Indexed: 11/29/2022] Open
Abstract
Hymenoptera venom allergy (HVA) is the leading cause of anaphylactic reactions in adults and the second most common cause in children. Venom immunotherapy (VIT) is used to elicit an immune tolerance against hymenoptera venom in allergic patients and is based on the administration of purified venom extracts regularly for defined periods. The protocols of administration include 2 phases: an up-dosing phase that incrementally reaches the final dose resulting in a protective effect, and a maintenance phase in order to obtain the sustained effect. The goal of this review is to detail the efficacy and the safety of the up-dosing phase also named rush. Pathophysiological mechanisms, indications of VIT and technical aspects of up-dosing protocol are also covered.
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Affiliation(s)
- Vianney Gruzelle
- Department of Paediatric Pneumology and Allergology, University Hospital Centre of Toulouse, Toulouse, France
| | - Claire Mailhol
- Department of Respiratory Medicine and Allergic Diseases, University Hospital Centre of Toulouse, Toulouse, France.,Mastocytosis Reference Centre and Dermatology Department, University Hospital Centre of Toulouse, Toulouse, France
| | - David W Waters
- Center for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France
| | - Laurent Guilleminault
- Department of Respiratory Medicine and Allergic Diseases, University Hospital Centre of Toulouse, Toulouse, France.,Center for Pathophysiology Toulouse Purpan, INSERM U1043, CNRS UMR 5282, Toulouse III University, Toulouse, France
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Mehlich J, Fischer J, Hilger C, Swiontek K, Morisset M, Codreanu-Morel F, Schiener M, Blank S, Ollert M, Darsow U, Biedermann T, Eberlein B. The basophil activation test differentiates between patients with alpha-gal syndrome and asymptomatic alpha-gal sensitization. J Allergy Clin Immunol 2018; 143:182-189. [PMID: 30125663 DOI: 10.1016/j.jaci.2018.06.049] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/03/2018] [Accepted: 06/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Galactose-alpha-1,3-galactose (alpha-gal) syndrome is characterized by the presence of serum specific IgE antibodies to alpha-gal and delayed type I allergic reactions to the carbohydrate alpha-gal after consumption of mammalian (red) meat products and drugs of mammalian origin. Diagnostics currently rely on patient history, skin tests, determination of serum specific IgE antibodies, and oral food or drug challenges. OBJECTIVE We sought to assess the utility of different basophil parameters (basophil reactivity and sensitivity, the ratio of the percentage of CD63+ basophils induced by the alpha-gal-containing allergen to the percentage of CD63+ basophils after stimulation with anti-FcεRI antibody [%CD63+/anti-FcεRI], and area under the dose-response curve [AUC]) as biomarkers for the clinical outcome of patients with alpha-gal syndrome compared with subjects with asymptomatic alpha-gal sensitization. METHODS In addition to routine diagnostics, a basophil activation test (Flow CAST) with different concentrations of alpha-gal-containing allergens (eg, commercially available alpha-gal-carrying proteins and pork kidney extracts) was performed in 21 patients with alpha-gal syndrome, 12 alpha-gal-sensitized subjects, and 18 control subjects. RESULTS Alpha-gal-containing allergens induced strong basophil activation in a dose-dependent manner in patients. Basophil reactivity at distinct allergen concentrations, the %CD63+/anti-FcεRI ratio across most allergen concentrations, the AUC of dose-response curves, and basophil allergen threshold sensitivity (CD-sens) with pork kidney extract were significantly higher in patients with alpha-gal syndrome compared with those in sensitized subjects. All parameters were negative in control subjects. CONCLUSION The basophil activation test should be considered as an additional diagnostic test before performing time-consuming and potentially risky oral provocation tests. The %CD63+/anti-FcεRI ratio for all allergens and AUCs for pork kidney were the best parameters for distinguishing patients with alpha-gal syndrome from subjects with asymptomatic alpha-gal sensitization.
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Affiliation(s)
- Jana Mehlich
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Jörg Fischer
- Department of Dermatology, Faculty of Medicine, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Christiane Hilger
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Kyra Swiontek
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Martine Morisset
- Immunology-Allergology Department, Luxembourg Hospital, Luxembourg-Ville, Luxembourg
| | | | - Maximilian Schiener
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Simon Blank
- Center of Allergy and Environment (ZAUM), Technical University of Munich and Helmholtz Center Munich, Munich, Germany
| | - Markus Ollert
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Ulf Darsow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany.
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Chirumbolo S, Bjørklund G, Sboarina A, Vella A. The role of basophils as innate immune regulatory cells in allergy and immunotherapy. Hum Vaccin Immunother 2018; 14:815-831. [PMID: 29257936 DOI: 10.1080/21645515.2017.1417711] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Basophils are circulating cells that are associated quite exclusively with allergy response and hypersensitivity reactions but their role in the immune network might be much more intriguing and complex than previously expected. The feasibility of testing their biology in vitro for allergy research and diagnosis, due fundamentally to their quite easy availability in the peripheral blood, made them the major source for assessing allergy in the laboratory assay, when yet many further cells such as mast cells and eosinophils are much more involved as effector cells in allergy than circulating basophils. Interestingly, basophil numbers change rarely in peripheral blood during an atopic response, while we might yet observe an increase in eosinophils and modification in the biology of mast cells in the tissue during an hypersensitivity response. Furthermore, the fact that basophils are very scanty in numbers suggests that they should mainly serve as regulatory cells in immunity, rather than effector leukocytes, as still believed by the majority of physicians. In this review we will try to describe and elucidate the possible role of these cells, known as "innate IL4-producing cells" in the immune regulation of allergy and their function in allergen immunotherapy.
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Affiliation(s)
- Salvatore Chirumbolo
- a Department of Neurological and Movement Sciences , University of Verona , Verona , Italy
| | - Geir Bjørklund
- b Council for Nutritional and Environmental Medicine (CONEM) , Mo i Rana , Norway
| | - Andrea Sboarina
- c Department of Surgery , Dentistry, Paediatrics and Gynaecology-University of Verona , Verona , Italy
| | - Antonio Vella
- d Unit of Immunology-Azienda Ospedaliera Universitaria Integrata (AOUI) , Verona , Italy
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9
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Korošec P, Šilar M, Kopač P, Eržen R, Zidarn M, Košnik M. Distinct Contributory Factors Determine Basophil-Allergen Sensitivity in Grass Pollen Rhinitis and in Anaphylactic Wasp Venom Allergy. Int Arch Allergy Immunol 2016; 171:89-101. [PMID: 27907922 DOI: 10.1159/000452102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 09/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We sought to determine whether basophil-allergen sensitivity could be transferred to donor basophils by passive IgE sensitisation in allergic rhinitis and anaphylactic Hymenoptera venom hypersensitivity. METHODS We studied 15 wasp venom-, 19 grass pollen- and 2 house dust mite-allergic patients, 2 healthy donors, and 8 wasp venom-allergic donors. In all subjects, we first evaluated the initial basophil response to wasp venom, grass pollen, or house dust mite allergen. Donor basophils were then stripped, sensitised with the different patients' serum IgE, and challenged with the corresponding allergen. The CD63 response of donor basophils was then compared with initial basophil responses. RESULTS In wasp venom-allergic subjects, the IgE transfer did not reflect the initial basophil-allergen sensitivity, because the venom IgE of subjects with high or low basophil sensitivity induced comparable responsiveness in healthy donor basophils. Furthermore, vice versa, when we sensitised the donor basophils of wasp venom-allergic individuals with different wasp venom or house dust mite IgE, we demonstrated that their response was predictable by their initial basophil allergen sensitivity. In the rhinitis allergy model, the IgE transfer correlated with the patients' initial basophil responsiveness because the grass pollen IgE of the subjects with high basophil allergen sensitivity induced significantly higher responsiveness of donor basophils than the IgE of subjects with initially low basophil allergen sensitivity. CONCLUSIONS Our results suggest that basophil allergen sensitivity evaluated by flow-cytometric CD63 analysis depends on two distinct contribution factors. In anaphylactic Hymenoptera allergy, the major factor was intrinsic cellular sensitivity, whereas in pollen allergy, the major factor was allergen-specific IgE on the cell surface.
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Affiliation(s)
- Peter Korošec
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
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Korošec P, Žiberna K, Šilar M, Dežman M, Čelesnik Smodiš N, Rijavec M, Kopač P, Eržen R, Lalek N, Bajrović N, Košnik M, Zidarn M. Immunological and clinical factors associated with adverse systemic reactions during the build-up phase of honeybee venom immunotherapy. Clin Exp Allergy 2015; 45:1579-89. [DOI: 10.1111/cea.12582] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 04/24/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022]
Affiliation(s)
- P. Korošec
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - K. Žiberna
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - M. Šilar
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - M. Dežman
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | | | - M. Rijavec
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - P. Kopač
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - R. Eržen
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - N. Lalek
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - N. Bajrović
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - M. Košnik
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
| | - M. Zidarn
- University Clinic of Respiratory and Allergic Diseases; Golnik Slovenia
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