Diagnostic relevance of IgE sensitization profiles to eight recombinant Phleum pratense molecules

BACKGROUND

Grass pollen-related seasonal allergic rhinoconjunctivitis (SARg) is clinically heterogeneous in severity, comorbidities, and response to treatment. The component-resolved diagnostics disclosed also a high heterogeneity at molecular level. Our study aimed at analyzing the characteristics of the IgE sensitization to Phleum pratense molecules and investigating the diagnostic relevance of such molecules in childhood.

METHODS

We examined 1120 children (age 4-18 years) with SARg. Standardized questionnaires on atopy were acquired through informatics platform (AllergyCARD™). Skin prick tests were performed with pollen extracts. Serum IgE to airborne allergens and eight P. pratense molecules (rPhl p 1, rPhl p 2, rPhl p 4, rPhl p 5b, rPhl p 6, rPhl p 7, rPhl p 11, rPhl p 12) were tested by ImmunoCAP FEIA.

RESULTS

The analysis of IgE responses against eight P. pratense molecules showed 87 profiles. According to the number of molecules recognized by IgE, the more complex profiles were characterized by higher serum total IgE, higher grass-specific serum IgE, and higher number and degree of sensitization to pollens. The most frequent IgE sensitization profile was the monomolecular Phl p 1. Sensitization to Phl p 7 was a reliable biomarker of asthma, whereas Phl p 12 of oral allergy syndrome. Sensitization to Phl p 7 was associated with a higher severity of SARg, and complex profiles were associated with longer disease duration.

CONCLUSIONS

In a large pediatric population, the complexity of IgE sensitization profiles against P. pratense molecules is related to high atopic features although useless for predicting the clinical severity. The detection of serum IgE to Phl p 1, Phl p 7, and Phl p 12 can be used as clinical biomarkers of SARg and comorbidities. Further studies in different areas are required to test the impact of different IgE molecular profiles on AIT response.

Endotypes of pollen-food syndrome in children with seasonal allergic rhinoconjunctivitis: a molecular classification

BACKGROUND

Pollen-food syndrome (PFS) is heterogeneous with regard to triggers, severity, natural history, comorbidities, and response to treatment. Our study aimed to classify different endotypes of PFS based on IgE sensitization to panallergens.

METHODS

We examined 1271 Italian children (age 4-18 years) with seasonal allergic rhinoconjunctivitis (SAR). Foods triggering PFS were acquired by questionnaire. Skin prick tests were performed with commercial pollen extracts. IgE to panallergens Phl p 12 (profilin), Bet v 1 (PR-10), and Pru p 3 (nsLTP) were tested by ImmunoCAP FEIA. An unsupervised hierarchical agglomerative clustering method was applied within PFS population.

RESULTS

PFS was observed in 300/1271 children (24%). Cluster analysis identified five PFS endotypes linked to panallergen IgE sensitization: (i) cosensitization to ≥2 panallergens ('multi-panallergen PFS'); (ii-iv) sensitization to either profilin, or nsLTP, or PR-10 ('mono-panallergen PFS'); (v) no sensitization to panallergens ('no-panallergen PFS'). These endotypes showed peculiar characteristics: (i) 'multi-panallergen PFS': severe disease with frequent allergic comorbidities and multiple offending foods; (ii) 'profilin PFS': oral allergy syndrome (OAS) triggered by Cucurbitaceae; (iii) 'LTP PFS': living in Southern Italy, OAS triggered by hazelnut and peanut; (iv) 'PR-10 PFS': OAS triggered by Rosaceae; and (v) 'no-panallergen PFS': mild disease and OAS triggered by kiwifruit.

CONCLUSIONS

In a Mediterranean country characterized by multiple pollen exposures, PFS is a complex and frequent complication of childhood SAR, with five distinct endotypes marked by peculiar profiles of IgE sensitization to panallergens. Prospective studies in cohorts of patients with PFS are now required to test whether this novel classification may be useful for diagnostic and therapeutic purposes in the clinical practice.

Perioperative Latex Allergy

The prevalence of latex allergy varies greatly depending on the population studied and the methods used to detect sensitization. Subjects considered to be at high risk for latex allergy are rubber industry workers, children with spina bifida and urological abnormalities, children undergoing multiple surgical procedures and with urinary catheterization, health care workers and people with food allergy (latex fruit syndrome). In this paper we report a review of latex proteins, the symptoms of latex allergy, diagnosis and management in subjects with latex allergy.

The inverse association of salmonellosis in infancy with allergic rhinoconjunctivitis and asthma at school-age: a longitudinal study

BACKGROUND

Respiratory allergies are inversely related to early acquisition of food-borne and fecal-oral infections, consumption of unpasteurized milk, early exposure to stables and high endotoxin concentrations in a farming environment. We tested therefore if infection by Salmonella in early life can protect from development of respiratory allergies later in life.

METHODS

During 2003, we studied two groups of Sardinian children (age 6-18 years) who had been hospitalized before 4 years of age (during 1989-2001) with non-typhoid salmonellosis (n = 148) or acute enteritis of nonbacterial etiology (NB-enteritis) (n = 167). Allergic rhinoconjunctivitis (AR) and asthma were evaluated by telephonic interview with a ISAAC questionnaire; participants reporting AR and/or asthma were further examined through a complete diagnostic work-up to objectively confirm or exclude current disease. Kaplan-Meier curves and Cox proportional hazard models were used to analyze the role of different types of enteritis on the risk of developing allergic rhinoconjunctivitis or asthma over time.

RESULTS

Children who had been hospitalized with salmonellosis had a lower prevalence of allergic rhinoconjunctivitis (eight of 148, 5.4%vs 23 of 167, 13.8%; P = 0.019) or asthma (five of 148, 3.4% vs 21 of 167, 12.6%; P = 0.006) than those who had been hospitalized with NB-enteritis. The proportional hazard of salmonellosis for asthma was 0.23 (95% CI: 0.08-0.67; P < 0.01) and for allergic rhinoconjunctivitis was 0.40 (95% CI: 0.17-0.95; P = 0.04), after adjusting for confounders.

DISCUSSION

The strength of the observed associations suggests that Salmonella may contribute to shape the natural history of respiratory allergies. However, further studies are needed to test in other settings the association observed in Sardinian children. We speculate that clinical or subclinical infection by Salmonella may contribute to the atopy protective influence of a traditional farming environment or of areas endemic for food-borne and fecal-oral infections. Food hygiene and prevention of salmonellosis must remain however a public health priority.

[Nedocromil in the treatment of chronic asthma in children. A double-blind vs placebo study]

After 2 weeks of observation, Nedocromil has been studied in double blind vs placebo for 8 weeks in 40 children with asthma of medium seriousness. Patients had to record on a clinical diary symptoms (wheezing and cough), beta 2-agonists consumption and collateral effects of the drug. Every 2 weeks patients had a clinical examination and the physician's judgement about the treatment's efficiency was registered. Patients who took the active drug had an improvement in symptoms from the 3rd week of observation and a significative decrease in bronchodilators' consumption. The judgement about the treatment's efficiency was different between physician and patients thus preventing the recognition of the patients who had taken Nedocromil from those who had taken placebo. We think that the different consumption of beta 2-agonists could be the reason for this behaviour between the 2 groups.

[Clinical effectiveness of a new preparation of sustained-release theophylline]

Twenty pediatric patients, age range 7-13 years, affected by asthma, have been treated with a sustained release preparation of theophylline once daily (mean dosage 13 mg/kg). The findings of plasma levels of theophylline below therapeutic range twenty four hours after dosing, in steady-state conditions, underline the need of individualized therapy specially in pediatric patients. The Authors observed a good therapeutic effect of this sustained release preparation, as expressed by improvement of symptomatology and pulmonary function tests, together with the sparing effect on other drugs. No side effects have been observed.

[Efficacy of broxaterol (vs salbutamol) in asthma induced by physical exercise in children]

B2-agonists play a first-rate role in the exercise induced asthma (EIA) prevention for their capacity to modulate the bronchial tone. We studied the efficacy of a new B-sympathomimetic (Broxaterol) in 10 children (7 males and 3 females) with EIA in double blind vs salbutamol. During two consecutive days a basal treadmill incremental exercise test was made for determining bronchoconstriction rate (IB). Subsequently the test was repeated 30' and 150' after the drug's administration. The Broxaterol premedication determined, by comparison with the basal IB value, a mean difference of 11.9 after 30' (p less than 0.05) and 10.0 after 150' (p less than 0.01). No significant correlation was found comparing the salbutamol premedication. In conclusion our data confirms the Broxaterol efficacy in exercise-induced asthma prevention.

[Effectiveness of a new beta 2-agonist (broxaterol) on bronchospasm induced by methacholine (blind study versus salbutamol)]

A new beta 2-agonists, broxaterol, administered by oral spray has been tested to evaluate its action modifying on the bronchial hyperreactivity to metacholine. Such drug has been administered double blind Vs salbutamol individualizing for both, at 15' and 90' premedication the PD20 FEV1 (doses of metacholine necessary to reduce of 20% the FEV1). The results that we have obtained confirm the protective capacity for both drugs on the bronchoconstriction induced by aspecific stimulus. However, in confront with salbutamol, the broxaterol presents an action more lasting in the time. Such requisite and absence of collateral effects permit to affirm that this new beta 2-agonists is fit for its utilization in the infantile intrinsic asthma.

[Procaterol in the prevention of recurrent asthmatic bronchitis. Double-blind study]

In a study in double-blind it has considered if the procaterol, given for a month, had been able to develop a preventive action in children affected from relapsing asthmatic bronchitis. For that the clinical symptomatology, the number of the contagious events and the consumption of the drugs have been valued for two following months. The patients who had taken the procaterol, presented a reduction of the contagious events, of the consumption of the drugs and of the spastic bronchus symptomatology in the first month of the treatment which continued in the second month. In spite of the development of the contagious events, in the third month, the pulmonary symptomatology resulted inferior in comparison with the group of check. It is likely than the treatment with procaterol avoids the arisen of the spastic-bronchus symptomatology for a rise of the threshold of bronchial re-established, consequent to the re-establishment of the mucous lesions.

[Aspects and behavior of x-ray computed tomographic studies in subacute sclerosing panencephalitis]

The authors reports cerebral Computerized Axial Tomography findings examined, in association with other diagnostic tests, in 5 cases of Subacute Sclerosing Panencephalitis in the acute phase and repeated in 2 of these patients later, during the state and terminal phases of the disease. Hypodensity of the white matter was the main sign of initial cerebral parenchymal involvement and an atrophic aspect was most indicative of the terminal phase. Moreover, it has been shown that associated with clinical symptomatology, immunologic data and EEG signs, cerebral Computerized Axial Tomography may offer the possibility for evaluating the nature and the evolutive stage of the disease and facilitate differential diagnosis from other degenerative encephalopathies.