The Association between Tobacco Smoke and Serum Immunoglobulin E Levels in Korean Adults

Clinical Response to Low-dose Omalizumab Treatment in Chronic Spontaneous Urticaria: A Retrospective Study of 179 Patients

Omalizumab is effective in chronic spontaneous urticaria unresponsive to antihistamines. Of the licensed dosing schedules, Korean patients prefer a low dose, of 150 mg/month, for financial reasons. However, real-world experiences of low-dose omalizumab consumption have not been reported. The aim of this retrospective study was to assess the treatment outcomes and long-term clinical course of patients with chronic spontaneous urticaria who were treated with low-dose omalizumab. The study included 179 patients aged ≥ 20 years who were treated with omalizumab 150 mg/month for ≥ 12 weeks. Baseline disease activity was mild, moderate, and severe in 54.7%, 35.2%, and 10.1% of patients, respectively. A complete response was observed in 133 patients at 12 weeks, among whom 88 patients showed early responses within 4 weeks. Overall, 158 patients finally achieved a complete response. Multivariate analyses revealed that baseline disease activity is more likely to be mild in patients who experience early and final complete responses. The absence of atopic comorbidities correlated with an early response. Smoking was associated with a final complete response. This study shows that low-dose omalizumab provides favourable treatment outcomes in antihistamine-refractory chronic spontaneous urticaria. Disease severity, atopic comorbidity, and smoking may be predictive factors for studying the response to omalizumab.

Prevalence and Risk Factors of Allergic Diseases Among School Students in Tabuk: A Cross-Sectional Study

BACKGROUND

Allergic diseases such as bronchial asthma, allergic rhinitis, and atopic dermatitis are common health problems among children. The prevalence of different allergic diseases is increasing in the Kingdom of Saudi Arabia.

OBJECTIVES

This study aimed to estimate the prevalence and risk factors of allergic diseases among school students in Tabuk, Saudi Arabia.

METHODS

This cross-sectional analytical study was conducted in Tabuk city, Saudi Arabia, between the first of August and the end of September, 2022. Students from primary, intermediate, and secondary schools were included. A predesigned, structured, self-administered questionnaire in the Arabic language was used to collect data.

RESULTS

This study included 384 school students from Tabuk, Saudi Arabia. The age of the recruited students ranged from five to 19 years old. The prevalence of clinically diagnosed bronchial asthma that occurred at any time in the past was 31.8%. The prevalence of asthma symptoms was 51.0% for lifetime wheezing and 45.8% for current wheezing (in the past 12 months). The prevalence rates of clinically diagnosed allergic rhinitis and atopic dermatitis were 56.8% and 30.2%, respectively. Further, 68.2% of the school students had one or more of the diagnosed allergic diseases. The second or more childbirth orders were significantly associated with an increased risk of allergic diseases (adjusted odds ratio [AOR] = 3.140, 95% CI: 1.864-5.288). A family history of asthma or atopic conditions showed 3.118 times increased likelihood of allergic conditions (AOR = 3.118, 95% CI: 1.827-5.320). Other significant risk factors were the father's smoking (AOR = 1.698, 95% CI: 1.024-2.817) and having a dog, cat, or bird at home (AOR = 0.493, 95% CI: 0.257-0.946).

CONCLUSION

The prevalence of bronchial asthma and other allergic diseases such as allergic rhinitis and atopic dermatitis among school students in Tabuk city, Saudi Arabia, is alarmingly high. Furthermore, both genetic and environmental components of allergic disease pathogenesis have been identified as risk factors.

Cross-sectional Study of Workers Employed at a Copper Smelter-Effects of Long-term Exposures to Copper on Lung Function and Chronic Inflammation

OBJECTIVE

The aim of the study was to assess the effect of exposure to copper-containing dust on lung function and inflammatory endpoints among workers of a German copper plant, effects rarely studied before.

METHODS

One hundred four copper-exposed smelter workers and 70 referent workers from the precious metal and lead facilities were included, with different metal exposures in both groups due to the different process materials. Body plethysmography, exhaled nitric oxide (FeNO) measurements, and blood sampling were conducted in all workers. Smoking status and the use of respiratory protective equipment were considered. In a subgroup of 40 nonsmoking volunteers (28 copper-exposed and 12 referents), sputum biomarkers were assessed.

RESULTS

Median lung function values of both copper-exposed and the referent groups were within reference ranges of "healthy" individuals, and statistical differences between the groups were mostly not evident. Similarly, differences in blood and sputum biomarkers were too small to be biologically relevant.

CONCLUSION

The results suggest the absence of the detectable effects of copper-containing dust exposure on lung function or chronic inflammation within the investigated cohort.

Association between exposure to chemical mixtures in relation to serum total IgE among adults 19-86 years old

There is a scarcity of studies on the effects of mixed chemicals on total IgE. We aim to assess whether there is a link between chemical mixtures (blood and urine of 26 chemicals including lead, mercury, cadmium, t,t-muconic acid, benzylmercapturic acid , 1-hydroxypyrene, 2-naphthol, 2-hydroxyfluorene, 1-hydroxyphenanthrene, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-n-butyl phthalate, mono-benzyl phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, mono-carboxyoctyl phthalate, mono-carboxy-isononly phthalate, mono (3-carboxypropyl) phthalate, bisphenol A, bisphenol F, bisphenol S, triclosan, methylparaben, ethylparaben, propylparaben, 3-phenoxybenzoic acid, and cotinine), and total IgE in 3,642 Korean adults aged ≥ 19. The effects of mixed chemical exposure on total IgE were identified using linear regression models, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR). The most relevant factors linked with IgE, according to the linear regression models, were blood or urine mercury and urine bisphenol A levels, with significant trends detected for these chemical tertiles (p < 0.01). The WQS index was significantly linked with ln2-transformed levels of serum total IgE (β = 0.30, 95 %CI 0.25-0.32). The qgcomp index also found a significant link between chemicals and ln2-transformed levels of serum total IgE (β = 0.52, 95 %CI 0.21-0.82), and elevated serum total IgE levels (OR = 2.55, 95 %CI 1.14-5.71). In BKMR analysis, the overall effect of the mixture was significantly associated with ln2-transformed levels of serum total IgE. The cutoff levels for exposure levels related to serum total IgE levels/elevated serum total IgE levels were reported. We discovered that whole-body exposure to 26 chemicals was associated with serum total IgE levels after assessing the findings of these four models. More research is needed in the future to gain a better understanding of the impact of mixed chemical exposure on allergic disorders and how to minimize chemical exposure, especially for people under the age of 18.

Allergic Diseases: A Comprehensive Review on Risk Factors, Immunological Mechanisms, Link with COVID-19, Potential Treatments, and Role of Allergen Bioinformatics

The prevalence of allergic diseases is regarded as one of the key challenges in health worldwide. Although the precise mechanisms underlying this rapid increase in prevalence are unknown, emerging evidence suggests that genetic and environmental factors play a significant role. The immune system, microbiota, viruses, and bacteria have all been linked to the onset of allergy disorders in recent years. Avoiding allergen exposure is the best treatment option; however, steroids, antihistamines, and other symptom-relieving drugs are also used. Allergen bioinformatics encompasses both computational tools/methods and allergen-related data resources for managing, archiving, and analyzing allergological data. This study highlights allergy-promoting mechanisms, algorithms, and concepts in allergen bioinformatics, as well as major areas for future research in the field of allergology.

Atopic Dermatitis: Disease Characteristics and Comorbidities in Smoking and Nonsmoking Patients from the TREATgermany Registry

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke.

OBJECTIVES

In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients.

METHODS

TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers.

RESULTS

Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet.

CONCLUSIONS

German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

Peptide-based immunotherapy against oxidized elastin ameliorates pathology in mouse model of smoke-induced ocular injury

PURPOSE

Age-related macular degeneration (AMD), the leading cause of blindness in western populations, is associated with an overactive complement system, and an increase in circulating antibodies against certain epitopes, including elastin. As loss of the elastin layer of Bruch's membrane (BrM) has been reported in aging and AMD, we previously showed that immunization with elastin peptide oxidatively modified by cigarette smoke (ox-elastin), exacerbated ocular pathology in the smoke-induced ocular pathology (SIOP) model. Here we asked whether ox-elastin peptide-based immunotherapy (PIT) ameliorates damage.

METHODS

C57BL/6J mice were injected with ox-elastin peptide at two doses via weekly subcutaneous administration, while exposed to cigarette smoke for 6 months. FcγR-/- and uninjected C57BL/6J mice served as controls. Retinal morphology was assessed by electron microscopy, and complement activation, antibody deposition and mechanisms of immunological tolerance were assessed by Western blotting and ELISA.

RESULTS

Elimination of Fcγ receptors, preventing antigen/antibody-dependent cytotoxicity, protected against SIOP. Mice receiving PIT with low dose ox-elastin (LD-PIT) exhibited reduced humoral immunity, reduced complement activation and IgG/IgM deposition in the RPE/choroid, and largely a preserved BrM. While there is no direct evidence of ox-elastin pathogenicity, LD-PIT reduced IFNγ and increased IL-4 within RPE/choroid. High dose PIT was not protective.

CONCLUSIONS

These data further support ox-elastin role in ocular damage in part via elastin-specific antibodies, and support the corollary that PIT with ox-elastin attenuates ocular pathology. Overall, damage is associated with complement activation, antibody-dependent cell-mediated cytotoxicity, and altered cytokine signature.

THYROTROPIN-RECEPTOR ANTIBODIES, IMMUNOGLOBULIN E AND ANTINUCLEAR ANTIBODIES IN PATIENTS WITH GRAVES' DISEASE AND GRAVES' ORBITOPATHY

CONTEXT

Thyrotropin-receptor antibodies (TRAb) are biomarkers of Graves' disease (GD) and Graves' orbitopathy (GO). Elevated immunoglobulin E (IgE) and antinuclear antibodies (ANA) were also found in GD patients.

OBJECTIVE

We aimed to assess TRAb, IgE and ANA in GD and GO patients and to evaluate the relationship between the immunological markers and smoking.

DESIGN

This was a comparative cross-sectional study carried out in a single tertiary care center from June 2018 to January 2020.

SUBJECTS AND METHODS

A total of 103 GD patients (mean age 51.2, 84 females) were divided into three subgroups: moderate-to-severe GO (n=36), mild GO (n=32) and "only GD" subgroup (n=35). Forty healthy controls (HC) (mean age 51.2, 36 females) were also included. TRAb were measured by a thyrotropin-binding inhibitory immunoglobulin (TBII) assay in GD patients; IgE and ANA - by an enzyme-linked immunosorbent assay in all subjects.

RESULTS

GD patients had higher IgE-positivity rate (p=0.04) and similar ANA-positivity compared to HC. Moderate-to-severe GO subgroup had the highest TBII (p<0.01), the lowest TBII-negativity rate (p<0.01) and the highest ANA-positivity rate (p=0.03) and was the only subgroup whose IgE-positivity rate was significantly higher than HC (25% vs. 7.5%). Mild GO and "only GD" patients had comparable TBII, TBII-negativity rate, IgE and ANA.Both GO subgroups had significantly higher smoking rate than "only GD" patients. Smoking was positively associated with IgE positivity (φ=0.22, p=0.03), and negatively with TBII negativity rate (φ=-0.24, p=0.02).

CONCLUSIONS

GD patients exhibit different immunological patterns depending on the presence and severity of GO. Smoking might be just one of the factors responsible for the clinical and immunological variety of GD. Further studies are needed.

Investigation of Serum Total IgE and Eosinophil Levels in Different Allergic Diseases Together with the Study of Their Correlations with Various Possible Allergens in Mosul City

Serum total IgE (tIgE) is frequently used in the diagnosis of allergic diseases in Mosul city and Iraq. However, neither normal nor elevated levels can exclude or confirm the diagnosis of these diseases. Here, we tried to evaluate the validity of tIgE in the diagnosis of allergic asthma(AS), allergic rhinitis(AR) and atopic dermatitis(AD) in a sample of Mosul population, to set up an optimum cut-off value for diagnosis of these diseases and to study its correlation with different parameters that might affect its level. 38 patients with AS, 27 with AR, 46 with AD and 45 healthy controls were included in this study. tIgE were determined by ELISA and compared between allergic diseases and controls. Blood eosinophilia was ascertained and correlated with tIgE levels. The geometric means of tIgE were 316.87 IU/ml (95% CI: 234.69 to 427.82) in AS, 262.07 IU/ml (95% CI:174.24 to 394.18) in AR and 270.48 IU/ml (95% CI:202.57 to 361.16) in AD compared to 16.90 IU/ml (95% CI:12.32 to 23.18) in healthy controls. tIgE in allergic diseases was significantly increased in comparison to healthy controls (P <.0001). Female gender influenced tIgE in AS, but not in AR or AD. tIgE predominated in younger age groups; however, no significant difference was found between younger and older groups. Optimum values for tIgE with best discriminative accuracy were 77 IU/ml for AS and 81 IU/ml for AR and AD. Eosinophils count appeared to be a useful adjunct, and correlate well with tIgE in the diagnosis of allergic diseases.

AllergoOncology: ultra-low IgE, a potential novel biomarker in cancer-a Position Paper of the European Academy of Allergy and Clinical Immunology (EAACI)

Elevated serum IgE levels are associated with allergic disorders, parasitosis and specific immunologic abnormalities. In addition, epidemiological and mechanistic evidence indicates an association between IgE-mediated immune surveillance and protection from tumour growth. Intriguingly, recent studies reveal a correlation between IgE deficiency and increased malignancy risk. This is the first review discussing IgE levels and links to pathological conditions, with special focus on the potential clinical significance of ultra-low serum IgE levels and risk of malignancy. In this Position Paper we discuss: (a) the utility of measuring total IgE levels in the management of allergies, parasitosis, and immunodeficiencies, (b) factors that may influence serum IgE levels, (c) IgE as a marker of different disorders, and d) the relationship between ultra-low IgE levels and malignancy susceptibility. While elevated serum IgE is generally associated with allergic/atopic conditions, very low or absent IgE may hamper anti-tumour surveillance, indicating the importance of a balanced IgE-mediated immune function. Ultra-low IgE may prove to be an unexpected biomarker for cancer risk. Nevertheless, given the early stage of investigations conducted mostly in patients with diseases that influence IgE levels, in-depth mechanistic studies and stratification of malignancy risk based on associated demographic, immunological and clinical co-factors are warranted.

Effects of Cigarette Smoke on the Nasal Respiratory and Olfactory Mucosa in Allergic Rhinitis Mice

Objective

Cigarette smoke (CS) exposure reportedly enhances allergic airway inflammation. However, some studies have shown an association between current cigarette smoke exposure and a low risk for allergic rhinitis. Thus, the impact of CS exposure on allergic rhinitis remains poorly understood. The purpose of this study was to investigate the effects of CS on the respiratory mucosa (RM) and the olfactory epithelium (OE) of mice with allergic rhinitis, as the effects may differ depending on the nasal histological compartments.

Methods

Eight-week-old male BALB/c mice were used for this study. We developed a mouse model of smoking by intranasally administering 10 doses of a CS solution (CSS), and a mouse model of allergic rhinitis by sensitization with intraperitoneal ovalbumin (OVA) injection and intranasal challenge with OVA. We examined the effects of CS on the nasal RM and OE in mice with or without allergic rhinitis using histological, serum, and genetic analyses. First, we examine whether CSS exposure induces allergic responses and then, examined allergic responses in the OVA-sensitized allergic rhinitis mice with or without CSS exposure.

Results

Short-term CSS administration intensified allergic responses including increased infiltration of eosinophils and inflammatory cells and upregulation of interleukin-5 expression in the nasal RM of OVA-immunized mice, although only CSS induced neither allergic responses nor impairment of the RM and OE. Notably, repetitive OVA-immunization partially impaired the OE in the upper-lateral area, but CSS administration did not reinforce this impairment in OVA-induced allergic mice.

Conclusion

Short-term CSS exposure strengthened allergic responses in the nasal RM and did not change the structure of the OE. These results suggest that patients with allergic rhinitis could experience exacerbation of allergic symptoms after CS exposure.

Cigarette smoking differentially affects immunoglobulin class levels in serum and saliva: An investigation and review

The aim of the present study was to compare concentrations of IgG, IgA, IgM and IgD in both serum and saliva samples from smoking and non-smoking individuals using a protein microarray assay. The findings were also compared to previous studies. Serum and saliva were collected from 48 smoking male individuals and 48 age-matched never-smoker male individuals. The protein microarray assays for detection of human IgG, IgM, IgA and IgD were established and optimized using Ig class-specific affinity-purified goat anti-human Ig-Fc capture antibodies and horseradish peroxidase (HRP)-conjugated goat anti-human Ig-Fc detection antibodies. The Ig class specificity of the microarray assays was verified, and the optimal dilutions of serum and saliva samples were determined for quantification of Ig levels against standard curves. We found that smoking is associated with reduced IgG concentrations and enhanced IgA concentrations in both serum and saliva. By contrast, smoking differentially affected IgM concentrations-causing increased concentrations in serum, but decreased concentrations in saliva. Smoking was associated with decreased IgD concentrations in serum and did not have a significant effect on the very low IgD concentrations in saliva. Thus, cigarette smoking differentially affects the levels of Ig classes systemically and in the oral mucosa. Although there is variation between the results of different published studies, there is a consensus that smokers have significantly reduced levels of IgG in both serum and saliva. A functional antibody deficiency associated with smoking may compromise the body's response to infection and result in a predisposition to the development of autoimmunity.