Sensitization to common food allergens is a risk factor for asthma in young Chinese children in Hong Kong.

Sensitization to aeroallergens is a major risk factor for asthma. Although patients frequently consider food ingestion as an asthma trigger, the relationship between serum food-specific IgE antibodies and childhood asthma in China remains unclear. We therefore conducted a case-control study on asthmatic children attending a university hospital-based outpatient clinic to investigate their pattern of food sensitization. Asthmatic patients underwent spirometric assessment, and peripheral blood was collected for serum-specific IgE antibodies to common food and inhalant allergens. Two hundred and thirty-one asthmatics (aged 9.3+/-4.3 years) and 79 age- and sex-matched controls were enrolled. The serum logarithmic total IgE concentrations in patients and controls were 2.49 and 1.92, respectively (p < 0.0001). Subjects with increased serum total IgE level were significantly more likely to have food sensitization than those with normal values (33% vs. 16%; p = 0.001). Twenty-nine (52%) of 56 asthmatics younger than 6 years old and seven (27%) of 26 age-matched controls hadfood-specific IgE in their sera (p = 0.035). Asthmatics with food-specific IgE also used more doses of as-needed bronchodilator weekly (p = 0.005). Nonetheless, no association was found between asthma diagnosis and sensitization to individual food allergens. Significant food sensitization, with food-specific IgE level above 95% predictive values for clinical food allergy as proposed by Sampson, was only found in two patients for peanut and three subjects for egg white. In conclusion, a significant association was found between asthma and the presence of food-specific IgE antibodies in young Chinese children. Significant sensitization to common foods is rare in this cohort.     

Evaluation of inflammatory markers interleukin-6 (IL-6) and matrix metalloproteinase-9 (MMP-9) in asthma

Introduction: Even though IL-6 and MMP-9 are associated with airway inflammation in asthma, there is paucity of data in Indian population. Objective: To determine the levels of IL-6 and MMP-9 in the serum of patients suffering from asthma, and correlate with (a) disease severity, as per GINA guidelines; (b) clinical phenotypes; and (c) response to treatment. Methodology: The levels of IL-6 and MMP-9 were compared between moderate persistent asthma (n = 25), severe persistent asthma (n = 25) and normal controls (n = 30). IL-6 and MMP-9 were measured by ELISA (R&D Systems Inc., USA and Canada) and compared between controls and asthmatics and between groups of different asthma severity, clinical variables, spirometry, and allergen sensitization. Spirometry was repeated after 2 months of ICS+LABA to assess response to treatment in relation to baseline IL-6 and MMP-9 levels. Results: We observed a significant difference in both IL-6 and MMP-9 levels among asthmatics versus controls (p < 0.001), moderate versus severe persistent asthma (p < 0.001). A significant negative correlation was observed between MMP-9 and pre-bronchodilator FEV₁ and FVC, but not with IL-6. There was no association between IL-6 and MMP-9 with asthma duration, total IgE, AEC, number of allergens sensitized and degree of sensitization. No significant correlation (p > 0.5) was observed with IL-6 and MMP-9 levels and FEV₁ improvement after 2 months of ICS+LABA. Conclusion: Higher levels of IL-6 and MMP-9 were observed in asthmatics as compared to controls and in severe persistent asthma as compared to moderate persistent asthma, higher levels of MMP-9 was associated with lower lung functions.     

Perennial Allergen-Specific Immunoglobulin E Levels Among Inner-City Elderly Asthmatics

Background. The role of allergen sensitization has been well established among children and young adults with asthma. Some studies have suggested that allergens play a less important role among older patients with asthma. However, whether older asthmatics have a lower prevalence of allergen sensitization than younger adults remains controversial. The aim of this study was to access the prevalence of sensitization to indoor allergens in older compared to younger inner-city adults with persistent asthma. Methods. The authors used data collected as part of a cohort study of inner-city adults with persistent asthma. Sensitization to indoor allergens (specifically Dermatophagoides pteronyssinus, D. farinae, cat, mouse, Aspergillus fumigates, Alternaria, German and American cockroaches) was evaluated by specific immunoglobulin E (IgE) antibodies measured from peripheral blood. Univariate and multiple regression analyses were used to compare ratios of sensitization according to age (≤35, 36–59, ≥60 years of age). Results. Of the 245 patients in the study, 19% were over the age of 60 years. Overall 73%, 61%, and 41% of patients ≤35, 36–59, and ≥60 years old, respectively were sensitized to at least one indoor allergen (p = .01). Multivariate analysis showed that patients ≥60 years of age were significantly less likely to be sensitized (odds ratio 0.32, 95% confidence interval 0.11 to 0.89) compared to younger adults after controlling for potential confounders. Conclusions. Allergen sensitization is less common in older patients with persistent asthma. However, sensitization to any indoor allergen is relatively frequent in the elderly. Physicians should consider routinely accessing exposure and sensitization to these allergens as part of the evaluation of older inner-city patients with persistent asthma.     

Allergens in Household Dust and Serological Indicators of Atopy and Sensitization in Detroit Children with History-Based Evidence of Asthma

Background. Home exposure to allergens is an important factor in the development of sensitization and subsequent exacerbations of allergic asthma. We investigated linkages among allergen exposure, immunological measurements, and asthma by examining (1) reservoir dust allergen levels in homes, (2) associations between presence of allergens in homes and sensitization status of resident children, and (3) associations between asthma status and total IgE, atopy (by Phadiatop), and positive allergen-specific tests. Methods. The study protocol was approved by Institutional Review Boards (IRBs) of the University of North Carolina Chapel Hill; Westat, Inc.; and the US Environmental Protection Agency Human Research Protocol Office. Data were collected from questionnaires, serum analyses, and household vacuum dust. Children (n = 205) were predominately African American (AA) (85.4%) and 51.6% were asthmatic. Sera from 185 children and home dust samples (n = 141) were analyzed for total and specific IgE antibodies to allergens from cat and dog dander, cockroach, dust mites, mice, rats, and molds. Results. Sixty percent of the homes had detectable levels of three or more dust allergens. The proportions of children with positive allergen-specific IgE tests were dust mite (32%), dog (28%), cat (23%), cockroach (18%), mouse (5%), rat (4%), and molds (24–36%). Children testing positive to a single allergen also had positive responses to other allergens. Those children with positive serum tests for cat, dog, and dust mite lived in homes with detectable levels of cat (51%), dog (90%), and dust mite (Der f 1) (92%) allergens. Correlations between children’s specific IgE levels and dust levels were linearly related for dog (p < .04), but not for cat (p = .12) or dust mite (Der f 1) (p = .21). Odds ratios (95% CI) for the associations between asthma and serum-specific IgE were over 1.0 for cat, dog, dust mite (Der f 1), cockroach, and four types of molds. House dust allergen exposure levels, however, exhibited no differences between asthmatic and non-asthmatic homes. Conclusions. Both the co-occurrence of multiple allergens in dust and the high frequency of multiple allergen sensitizations indicate that a broad-based intervention aimed at reducing multiple allergens (pets, pests, and molds) would be more successful than any approach that aimed at reducing one type of allergen.     

Inhalant Allergens as Risk Factors for the Development and Severity of Mild-to-Moderate Asthma in Hong Kong Chinese Children

Sensitization to aeroallergens has been found to be a dominant risk factor for asthma in population-based studies. Similar results in asthmatic children being managed in hospital-affiliated outpatient clinic have not been established. We therefore conducted a case-control study on asthmatic children attending a university hospital-based outpatient clinic to investigate the pattern of aeroallergen sensitization, and to assess the correlation between asthma control and the presence of allergen-specific IgEs. Asthmatic patients underwent a questionnaire assessment of their asthma control, skin prick tests (SPT) for allergen sensitization, and spirometric evaluation. Peripheral blood was collected from all subjects for in vitro serum specific IgE assay (RAST) to common aeroallergens. One hundred and seventy asthmatics (aged 9.8 ± 3.7 years) and 57 age-matched control subjects were enrolled. Our patients had a median of two asthmatic attacks within 6 months prior to evaluation, and their median Disease Severity Score was 13. The median FEV₁ in our asthmatic children was 98%, whereas serum logarithmic total IgE concentrations in patients and controls were 2.57 and 2.09, respectively (p<0.0001). More than 85 % of our asthmatic children were sensitized to house-dust mite (HDM), and sensitization to HDM and cat, as well as elevated serum total IgE concentration, was a significant risk factor for the development of asthma in this cohort. Several objective measures of asthma severity, as well as FEV₁, correlated significantly with sensitization to HDM, pets, and cockroaches. In conclusion, indoor aeroallergens are one of the risk factors for the development and severity of mild-to-moderate asthma in Chinese children in Hong Kong.     

Serum levels of IL-10, IL-17F and IL-33 in patients with asthma: a case–control study

Objectives: The development of inflammation in asthma involves an intricate network of cytokines that recruit and activate numerous immune cells. This study was aimed to compare serum levels of IL-10, IL-17F, and IL-33 in asthmatic patients and non-asthmatic controls and correlate cytokine levels to asthma severity and various clinical, spirometric, and laboratory variables. Methods: Using ELISA, serum levels of IL-10, IL-17F, and IL-33 were evaluated in 44 asthmatics (14 mild persistent, 15 moderate persistent, and 15 severe persistent) and 44 controls. Results: This is one of the first reports showing a significant difference in serum levels of asthma-associated cytokines, anti-inflammatory IL-10, and pro-inflammatory IL-17F and IL-33, in the same subset of asthmatic patients. Our results showed diminished level of IL-10 and elevated levels of IL-17F and IL-33 in asthmatics than in controls (p?p?=?0.001). Conclusions: Negative correlation between IL-10 and IL-33 levels may reflect a converse relationship between anti-inflammatory and pro-inflammatory cytokines in an individually balanced pattern. The association between IL-17F level and asthmatic phenotypes such as reduced FVC and FEV1, higher degree of sensitization, and post-bronchodilator reversibility needs further assessments.     

The effect of mold sensitization and humidity upon allergic asthma

Introduction: Humidity is commonly associated with increased airway hyperresponsiveness in asthma. Objective: To examine mold sensitization in patients with allergic asthma or allergic rhinitis and self‐reports of humidity as exacerbating factors of clinical symptoms. Methods: A retrospective, cross‐sectional study at a University hospital outpatient allergy and asthma clinic was performed. A total of 106 patients with either allergic asthma or allergic rhinitis completed standard prick‐puncture skin testing with 17 allergens and controls and completed standardized forms addressing trigger factors for clinical symptoms. Results: Allergic asthmatics sensitized to Cladosporium were more likely to have a more severe asthma severity class (odds ratio = 4.26, confidence interval = 1.30–16.93). Sensitization to Alternaria, Cladosporium, Helminthosporium, Aspergillus and Dermatophagoides pteronyssinus in asthma was associated with higher likelihood for previous hospitalization, while sensitization to Cladosporium, Helminthosporium, Aspergillus, Dermatophagoides pteronyssinus and cockroach in asthma was associated with higher likelihood of having reduced pulmonary function based on forced expiratory volume in 1 s. Furthermore, allergic asthmatics more commonly reported humidity as an exacerbating factor of symptoms than did patients only with allergic rhinitis (68.42% vs 42.86%, respectively; P < 0.05). Conclusion: Mold sensitization is highly associated with more severe asthma, while humidity is more of an exacerbating factor in patients with allergic asthma as compared with allergic rhinitis alone. Further delineation between mold sensitization and humidity is needed to determine whether these are independent factors in asthma. Please cite this paper as: Hayes D Jr, Jhaveri MA, Mannino DM, Strawbridge H and Temprano J. The effect of mold sensitization and humidity upon allergic asthma. Clin Respir J 2013; 7: 135–144.     

Allergy and Mucosal Eosinophil Infiltrate in Ulcerative Colitis

Background: Data on allergy in ulcerative colitis (UC) have led to conflicting conclusions without proving any causal association. In this report we have investigated the presence of allergy and its possible relation with chronic colonic inflammation in patients with UC. Methods: Fifty UC patients underwent clinical, endoscopic, and histologic evaluations. The allergologic study included family/personal history; prick/patch exposition to airborne, food, and contact allergens; total serum IgE; and quantification of eosinophils in peripheral blood and intestinal mucosa. Diagnosis of rhinitis, conjunctivitis, and asthma was confirmed by specific provocation tests. Fifty healthy subjects were studied as control group. Results: A higher prevalence of allergic symptoms was found in patients (56%) and their first-degree relatives (52%) than in controls (18% and 26%) (P &lt; 0.0001; P = 0.008). In patients skin tests showed increased rates of immediate (54%) and delayed-type (20%) hypersensitivity compared with controls (30% and 6%) (P = 0.01; P = 0.03). Diagnosis of allergic IgE-mediated disease was made in 19 cases and 6 controls (P = 0.01), and allergic contact dermatitis in 10 and 3, respectively (P = 0.03). IgE levels were higher in UC patients than in controls (P = 0.02). No dose-response relationship was found between degree of colonic tissue eosinophilia and clinical, endoscopic, and histologic disease severity. The degree of colonic tissue eosinophilia was higher in the presence of skin reactivity to food allergens. Conclusions: UC patients frequently show several markers of allergy. In particular, our data suggest an association between ulcerative colitis, tissue eosinophilia, and type-I allergy.     

Endothelial Dysfunction in Patients with Asthma: The Role of Polymorphisms of ACE and Endothelial NOS Genes

Both atopy and asthma are claimed to be associated with a Th-2 cytokine pattern. We sought to determine the contribution of atopy and asthma to the observed Th-2/Th-1 imbalance in these conditions. Of 60 children aged 6–16 years that were included in the study, 13 were nonatopic nonasthmatic, 15 atopic nonasthmatic, 14 nonatopic asthmatic, and 18 atopic asthmatic. Atopic children had positive skin prick tests to grass pollens only. All children were studied after an asymptomatic and drug-free period of at least three months. Total IgE was measured in serum. Peripheral blood mononuclear cells were cultured and stimulated in vitro with phytohemagglutinin and interferongamma (IFN-γ) and interleukin-4 (IL-4) measured in the supernatants. Total IgE was significantly higher in atopic asthmatics compared to nonatopic asthmatics (p = 0.004), and nonatopic nonasthmatics (p = 0.001), but was not different from atopic nonasthmatics (p > 0.05). On the other hand, IL-4 was significantly elevated in atopic asthmatics and in nonatopic asthmatics compared to nonatopic nonasthmatics (p = 0.037 and p = 0.009, respectively). Although atopic asthmatics had lower IFN-γ values than nonatopic asthmatics, the difference did not reach statistical significance. No correlation was detected between any two parameters. Our results suggest that both atopy and asthma contribute to the increased levels of IL-4 and that, whereas nonatopic asthma is associated with increases in both IL-4 and IFN-γ release by mononuclear cells, only atopic asthma is characterized by a Th-2 type cytokine dominance.     

Specific IgE to Common Food Allergens in Children with Atopic Dermatitis

Background: Atopic dermatitis is a major public health problem, often starting in early childhood and sometimes followed by other allergic diseases. Although hypersensitivity to foods is assumed to play an essential role in the development of atopic dermatitis in some patients, little is known about common food allergens in Iranian children with atopic dermatitis. Objectives: This study was designed to identify probable food allergens in Iranian children with atopic dermatitis and find the relationship between food sensitization and the severity of atopic dermatitis. Methods: This study included 90 children aged 2-48 months with atopic dermatitis. Skin prick tests for cow's milk, hen's egg, almond, potato and soybean were done. Serum specific IgE to 20 food allergens was also screened. Results: Among children with atopic dermatitis, the frequency of food sensitization was 40% by skin prick test and 51% by food-specific IgE. Children with atopic dermatitis were most commonly sensitized to cow's milk (31%), hen's egg (17.7%), tree nuts (17.7%), wheat (12.2%), potato (11.1%), tomato (8.8%) and peanut (8.8%). In 42 children with moderate to severe eczema, sensitivity to food allergens was 78.5% by skin prick test and 88% by serum specific IgE evaluation. Conclusion: Our results showed that cow's milk, hen's egg and tree nuts were the most common food allergens in Iranian children with atopic dermatitis. Sensitization to foods was much higher in patients with moderate to severe atopic dermatitis. Determining specific IgE in children with atopic dermatitis can be helpful in managing these patients.     

The Predictive Value of IgE as Biomarker in Asthma

Background. The evidence for a causal relationship between allergens and asthma depends on epidemiologic findings showing a strong association between specific immunoglobulin E (IgE) antibodies or total IgE and asthma. Objective. To clarify the relationship between total serum IgE levels and asthma. Study design. A cross–sectional study. Patients and methods. A total of 562 asthmatic patients were included in the study, and their age range was from 17 to 52 years. The subjects included in the study were outpatients from the Asthma and Allergy Centre or Samara General Hospital outpatients Clinic. The diagnosis of asthma was performed by a specialist physician and was established according to the National Heart Blood and Lung Institute/World Health Organization (NHLBI/WHO) workshop on the Global Strategy for Asthma. Results. This study indicated that mean serum IgE level was 554 ± 447 IU/mL in asthmatic patients, while that of the control population was 69 ± 33 IU/mL. There was no overlap in the values of 95% confidence interval (CI) of higher control limit and lower asthmatic limit values. Addition of two standard deviations to the mean IgE value of the control group (134 IU/mL) does not overlap with the lower 95% CI of the asthmatic group. However, serum IgE was within normal values in 5.9% of asthmatic patients in our study population. There was an inverse correlation between serum IgE levels and forced expiratory volume in 1 second (FEV₁) predicted percent for patients with asthma (r = ?0.73, p < 0.0001). The predictive value of serum IgE in asthma was determined using Receiver Operating Characteristics (ROC) curve method. From the ROC curve, it can be seen that it is possible to get both high sensitivity and high specificity if the right cut–off value was chosen. In fact, a cut–off of 200 IU/mL would indicate sensitivity of 93% and specificity of 91% in this group of patients and control subjects. Following immunotherapy there was 36% reduction in total serum IgE level. The value of IgE was significantly reduced (p < 0.001) from 956 ± 378 IU/mL at baseline to 613 ± 194 IU/mL after treatment. Conclusion. Serum IgE level was predictive in asthma, and it may be used to differentiate between asthmatic and non-asthmatic individuals in conjunction with other biomarkers. Specific immunotherapy reduced serum total IgE level in 36% of patients with asthma.     

Elevation of total serum immunoglobulin E is associated with asthma in nonallergic individuals.

Elevated serum immunoglobulin (Ig)E is the hallmark of atopy, and contributes to asthma and bronchial hyperresponsiveness in atopic individuals. In contrast, the significance of IgE in nonallergic subjects is less clear. The aim of the present study is to clarify a potential association of IgE and asthma in absence of clinical allergy. To this purpose 1,219 consecutive patients of a pulmonary practice were evaluated. Nonallergic patients were defined by negative skin prick test, history of atopy and specific IgE, 509 subjects (42%) were nonallergic. Among these, 80 patients (16%) had elevated total IgE levels (>150 U x mL(-1)). Prevalence and severity of asthma in nonallergic subjects with IgE>150 U x mL(-1) were compared with subjects with normal IgE levels, and lung function parameters were correlated with serum IgE in all nonallergic subjects and asthmatics. Asthma was more prevalent in nonallergic subjects with elevated IgE levels than in nonallergic subjects with normal IgE (39% versus 14%; p<0.001). Lung function values of nonallergic asthmatics were lower for forced expiratory volume in one second (FEV1)% predicted (66+20% versus 83+/-17%; p<0.001), FEV1% forced vital capacity (FVC) (70+/-14% versus 81+/-8%; p<0.001) and forced mid expiratory flow (FEF25-75) (1.7+/-0.9 L x s(-1) versus 2.8+/-0.9 L x s(-1); p=0.002) in patients with high IgE compared to asthmatics with normal IgE, and were negatively correlated with log IgE levels in all nonallergic asthmatics. (FEVI % pred: r=-0.5, p<0.001; FEV1% FVC: r=-0.53, p<0.001; FEF25-75: r=-0.52, p<0.001). In the whole study population, multivariate analysis showed a greater than fivefold asthma risk for nonallergic individuals with serum IgE>150 U x mL(-1). These data support the role of IgE as risk factor for asthma independent of allergy, and they further challenge the definition of intrinsic asthma as "non-IgE mediated" entity.     

ORMDL3/GSDMB genotype as a risk factor for early-onset adult asthma is linked to total serum IgE levels but not to allergic sensitization

BackgroundAn orosomucoid-like 3 (ORMDL3)/gasdermin B (GSDMB) gene locus on chromosome 17q is consistently associated with childhood-onset asthma, which is highly atopic. As some evidence suggests the relationship between asthma and allergic sensitization reflects asthma patient susceptibility to augmented IgE responses driven by common environmental allergens rather than an increased asthma risk after allergen exposure, we aimed to determine any relationships between this locus region and childhood-onset adult asthma with regard to serum total IgE levels or allergic sensitization.MethodsWe conducted a case–control association study using three independent Japanese populations (3869 total adults) and analyzed the ORs for association of rs7216389, an expression quantitative trait locus for ORMDL3/GSDMB, with adult asthma according to onset age. Additionally, associations between the rs7216389 genotype and total serum IgE levels or allergic sensitization was examined.ResultsRs7216389 was associated with both childhood-onset adult asthma (OR for asthmatic patients afflicted at the age of 10 years or younger = 1.61, p = 0.00021) and asthmatic patients with higher levels of total serum IgE (OR for asthmatic patients with IgE ≥1000IU/mL = 1.55, p = 0.0033). In both healthy controls and in the combined healthy and asthmatic individuals, rs7216389 was correlated with increased total serum IgE levels (p < 0.0005), but not allergic sensitization (p > 0.1).ConclusionsORMDL3/GSDMB is an important susceptibility gene for childhood-onset adult asthma in Japanese populations and this association is linked to elevated total serum IgE levels but not to allergic sensitization.     

Association of Urinary Bisphenol A Concentration with Allergic Asthma: Results from the National Health and Nutrition Examination Survey 2005–2006

Objective. Bisphenol A (BPA) is being increasingly associated with adverse health effects. Our objective was to determine whether urinary BPA concentration is associated with allergic asthma in a representative US population. Methods. Data for this analysis were obtained from the National Health and Nutrition Examination Survey 2005–2006 survey and included asthma-related questions, total immunoglobulin E (IgE), 19 allergen-specific IgE levels, and urinary environmental phenol measurements. Allergic asthma was defined as a history of asthma ever, high eosinophil count, and high total IgE or atopy. Association analyses included dichotomous and polychotomous logistic regression, receiver operating characteristic curves, Akaike information criterion, and likelihood ratio χ². Results. We found that 10-fold increase in BPA was independently associated with a higher likelihood of allergic asthma in females [odds ratio (OR) = 2.21, p = .032] but not in males (OR = 0.83, p = .474). These findings were reaffirmed when allergic asthma was defined based on atopy rather than total IgE (OR = 2.45, p = .001 in females and OR = 0.83, p = .605 in males). Urinary BPA was significantly associated with sensitization to various specific allergens in a dose–response manner. Lastly, urinary BPA independently predicted an asthma episode in the past 12 months in females but not in males. Conclusions. Urinary BPA is significantly associated with allergic asthma in females.     

Patterns of aeroallergen sensitization predicting risk for asthma in preschool children with atopic dermatitis

Objective: Atopic dermatitis (AD) is a chronic inflammatory skin disorder mostly affecting young children. Although several studies aimed to identify the risk factors for asthma in AD children, many aspects still need to be clarified. The aim of this study was to investigate the possible risk factors for asthma at school age in 99 children with early-onset and IgE-mediated AD. Methods: All children performed clinical evaluation and total and specific IgE assay for a panel of inhalant and food allergens at two different times (t₁ and t₂) during preschool, and asthma diagnosis was assessed at one follow-up visit (t₃) at school age. Results: At t₃, 39% of children had developed asthma. Of the variables compared, the sensitization to more than one class of inhalant allergens at t₂ (mean age?=?30 months) was associated with asthma, with grass (OR?=?3.24, p?=?0.020) and cat sensitization (OR?=?2.74, p?=?0.043) as independent risk factors. Conclusions: The sensitization pattern of a child with early-onset AD, also within the first 2–3 years of life, can reflect his risk to develop asthma. Therefore, testing these children for the more common allergens during this time frame should be recommended to predict the evolution of atopic diseases.     

Age at Onset of Asthma and Allergen Sensitization Early in Life

BackgroundEpidemiological evidence indicates that the age at onset of asthma and allergen sensitization in early life is decreasing in people from Western countries. To explore latent trends, we conducted a retrospective examination of the age at onset of asthma and specific IgE antibodies against inhalant allergens in Japanese asthmatic children.MethodsWe conducted a case series study of 103 consecutive children with atopic type of asthma (aged 2 years to 16 years, mean age 9.4 ± 3.4 years). Diagnoses of asthma and allergic rhinitis were defined according to Japanese guidelines. The onset of asthma and allergic rhinitis was also defined as any report of asthma and allergic rhinitis confirmed by a physician. Allergen sensitization was evaluated as specific serum IgE levels for 9 common inhalant allergens in peripheral blood. Atopic type of asthma was defined as a being positive for at least one aeroallergen.ResultsMean age at asthma onset was 2.3 ± 1.9 years, which is slightly lower than that of previous reports, including those published in Japan. A high prevalence rate of up to 80% was found for perennial antigens including Dermatophagoides spp. and house dust, as reported previously. Notably, some of the children aged at 1 year tested positive for these allergens.ConclusionsThe age at onset of asthma seems to be decreasing in comparison with previous reports. Furthermore, the age at onset of allergen sensitization against inhalant allergens appears to follow this trend.     

Respiratory allergy to airborne fungi in São Luís – MA: clinical aspects and levels of IgE in a structured asthma program

Introduction: Respiratory allergies are becoming increasingly frequent, especially based on studies of asthma and rhinitis. It is estimated that 20–30% of the world’s population is affected. Allergic reactions are caused by the production of IgE antibodies specific to inhaled allergens, such as fungi in the air. This study aimed to analyze the level of specific IgE against airborne fungi in patients with a clinical diagnosis of asthma and rhinitis/sinusitis. Methods: In total, 158 patients enrolled in the Program of Support for Asthmatic Patient, and 20 controls were studied. Clinical data from the period of 2007–2008 were surveyed using a protocol form. ELISAs were performed to quantify the levels of total and specific IgE. Results: Of the 158 patients diagnosed with asthma, 71 had rhinitis and 32 had sinusitis. There was a predominance of females and residents of urban areas. The main symptoms reported were dyspnea, cough, wheezing and nasal obstruction. There was a statistically significant relationship between dyspnea and seropositivity for Fusarium (p?=?0.01) and Penicillium (p?=?0.005) and between cough and seropositivity for Aspergillus (p?=?0.007). Conclusions: Anti-Penicillium (79.7%) and anti-Fusarium IgE (77.8%) were found to have the highest prevalence of seropositivity in individuals with asthma and rhinitis/sinusitis. Sensitivity to fungi was higher in symptomatic individuals. The identification of environmental fungi is essential for the diagnosis of respiratory allergy.     

Evaluation of angiotensin converting enzyme gene polymorphism and susceptibility to bronchial asthma among Egyptians

BackgroundAngiotensin converting enzyme (ACE) is expressed at high levels in the lungs and plays a role in the metabolism of the endogenous peptides involved in asthma pathogenesis. ACE gene polymorphisms have been reported to be linked to asthma. However, the results are conflicting, with no reported studies on Egyptian asthmatics. We aimed to assess ACE gene polymorphism among Egyptian asthmatics, and to determine its possible association with asthma severity.MethodsThis case–control study was conducted on 30 adult asthmatic patients, and 30 healthy controls with no history of asthma or atopy. Atopic status among asthmatics was determined by skin prick test (SPT). Lung functions were assessed by spirometry. Determination of ACE genotypes was performed for all subjects. Total serum IgE levels were measured by ELISA.ResultsThe frequencies of the DD, ID and II genotypes were 46.7%, 40%, and 13.3%, respectively among the cases, and 33.3%, 40%, and 26.7%, respectively among the controls. No significant differences in ACE genotype distribution were observed between cases and controls (p = 0.37). Genotype distribution did not differ according to age of onset or severity of asthma, total serum IgE levels, SPT positivity, or number of positive SPT reactions. Furthermore, ACE polymorphism was not statistically different between asthmatic patients without any associated atopic disease and those with an associated atopic disease.ConclusionThe results of our study indicate that ACE gene polymorphism is not significantly associated with bronchial asthma or with its severity among Egyptian adults.     

OX40 ligand: a potential costimulatory molecule in atopic asthma

Objective: We aimed to assess the percentage of peripheral blood B-lymphocytes expressing OX40 ligand (OX40L) in adult atopic and non-atopic asthmatic patients, and in healthy controls. Methods: This case–control study included 15 atopic asthmatic patients, 15 non-atopic asthmatic patients, and 15 healthy controls. Atopic status was determined by skin prick test reaction to the most common locally-encountered allergens. For all subjects, pulmonary function tests and measurement of total serum immunoglobulin E (IgE) levels by ELISA were performed. In addition, the percentage of B-lymphocytes expressing OX40L was assessed by flow cytometry in all three groups. Results: OX40L expression was significantly higher in atopic asthmatics than in non-atopic asthmatics and controls, but did not differ significantly between non-atopic asthmatics or controls. Among atopic asthmatics, OX40L expression correlated positively with total serum IgE levels, but not with age, disease duration, or values of forced expiratory volume in the first second. Conclusion: The over-expression of OX40L in atopic asthmatic patients appears to be linked to markers of the atopic status as total serum IgE, and signifies the vital role of OX40L in the atopic mechanism. Further large-scale studies are needed to investigate the role of OX40L in other atopic diseases and its relation to disease activity and severity.     

Biomarkers for differentiation of patients with asthma and chronic obstructive pulmonary disease

Objective: Asthma and chronic obstructive pulmonary disease (COPD) are airflow limitation diseases with similar clinical manifestations but different pathophysiologic mechanisms. To implement the appropriate treatment, it is important to distinguish between asthma and COPD which sometimes might result difficult in clinical practice. We evaluated biomarkers to distinguish between asthma and COPD. Methods: Blood eosinophil counts and fractional exhaled nitric oxide (FeNO) levels were analyzed. Serum periostin, interleukin-25 (IL-25), and immunoglobulin E (IgE) concentrations were compared between patients with asthma (n = 60), including atopic-asthma (n = 30) and non-atopic asthma (n = 30), and patients with COPD (n = 30). Results: Significantly higher peripheral blood eosinophil counts (p < 0.001), FeNO levels (p < 0.001), and total serum IgE (P = 0.003) concentrations, but not serum periostin (p = 0.584) or serum IL-25 (p = 0.085) concentrations, were detected in patients with asthma compared to patients with COPD. Serum periostin and IgE concentrations were increased in patients with atopic-asthma compared with those with non-atopic asthma and COPD (p < 0.05). The FeNO levels were significantly correlated with the peripheral blood eosinophil counts (r = 0.430, p = 0.001) and serum IL-25 concentrations (r = 0.338, p = 0.009) in patients with asthma. The serum periostin concentrations were also correlated with the serum IgE concentrations (r = 0.375, p = 0.003)and FeNO levels (r = 0.291, p = 0.024) in patients with asthma. Asthma patients were effectively differentiated from COPD patients based on the FeNO levels (p < 0.001) and peripheral blood eosinophil counts (p < 0.001). Conclusions: FeNO levels and peripheral blood eosinophil counts were useful biomarkers for distinguishing between patients with asthma and COPD. Serum periostin and IgE concentrations could be biomarkers for atopic asthma.