Platelet activation in allergic asthma patients during allergen challenge with Dermatophagoides pteronyssinus

BACKGROUND: Animal models of allergic asthma indicate that intravascular platelet activation is necessary for the development of allergen-induced chronic airway inflammation. OBJECTIVE: To evaluate whether the development of a late asthmatic response (LAR) in allergic asthma patients challenged with a relevant allergen is consequent to platelet activation. METHODS: Thirty-three house dust mite sensitive asthmatic patients were challenged intrabronchially with Dermatophagoides pteronyssinus (Dp) extract. Twelve non-atopic healthy subjects (HC) were used as controls. Platelet count and plasma levels of beta-thromboglobulin (beta-TG), platelet factor-4 (PF-4) and soluble P-selectin (sP-selectin) were assessed before the challenge (T(0)) and 30 min (T(EAR)), 6 h (T(LAR)) and 24 h (T(24)) after the challenge. RESULTS: Eleven patients responded to allergen challenge with an isolated early asthmatic response (single responders, SR). In 22 patients dual asthmatic response was demonstrated (dual responders, DR). At T(0) neither the platelet count nor the mean plasma level of beta-TG in DR or SR were different from HC, the mean plasma level of PF-4 in SR was significantly greater than in HC (P=0.01) or DR (P=0.001), the mean plasma level of sP-selectin was significantly greater in DR than in HC (0.0002) but not statistically different from SR (P=0.055). A significant decrease in the platelet count and increase in the plasma level of all the studied markers was seen at T(EAR), which was followed by a gradual return to the baseline values in the SR. Elevated plasma levels of platelet activation markers and decreased platelet count were seen in the DR even at T(24). Strong correlation was found between the increase in plasma concentration of beta-TG at T(EAR) and the maximum fall in forced expiratory volume in 1 s at T(LAR) (r=-0.57; P=0.0006). CONCLUSION: In allergic asthma patients development of prolonged airway inflammation after allergen challenge is associated with intravascular platelet activation.     

Enhanced Platelet Activation in Patients with Atopic Eczema/Dermatitis Syndrome

Data gathered prove that circulating platelets are activated upon human allergic inflammation, partly as a result of direct IgE-mediated process. It has been indicated that platelets may contribute to pathogenesis of atopic eczema/dermatitis syndrome (AEDS). Authors of the recent study have investigated systemic platelet activation in patients with AEDS on the basis of blood level of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4), which are recognized markers of platelet activation, also belonging to C-X-C chemokine family. Plasma levels of beta-TG and PF4 were measured by enzyme-linked immunoassay (ELISA) in 18 AEDS patients with moderate disease activity and 23 healthy, nonatopic individuals. No differences in peripheral platelet count of the two groups were noted. Only four (33.3%) AEDS patients represented beta-TG and PF4 within the control range; plasma beta-TG and PF4 were significantly increased (p < 0.001) in the AEDS group compared as a whole with the control subjects. No association between circulating concentrations of beta-TG or PF4 and total IgE levels in AEDS patients was proved. The results suggest that some patients with AEDS may have enhanced blood platelet activity as expressed by beta-TG and PF4 level.     

Platelet activity measured by plasma levels of beta-thromboglobulin and platelet factor 4 in seasonal allergic rhinitis during natural pollen exposure

Background: Upon activation, platelets release mediators with potent inflammatory properties in IgE-mediated immune responses. Moreover, the atopic state leads towards functional abnormalities of these cells. Objective: The aim of our study was to examine the degree of activation of circulating platelets in patients with seasonal allergic rhinitis (SAR) during the symptomatic period, to improve the understanding of platelet function in atopy. Subjects and Method: Plasma levels of beta-thromboglobulin (beta-TG) and platelet factor 4 (PF4) – specific markers of platelet activation were measured by enzyme-linked immunoassay in 20 patients suffering from SAR and in 15 healthy, nonatopic subjects. Results: There were no significant differences in peripheral blood platelet numbers and plasma levels of beta-TG and PF4 in SAR patients when compared with control subjects. Conclusion: It seems that increased in vivo platelet activity, assessed by measuring plasma beta-TG and PF4, may not occur during allergic inflammation that is associated with SAR.Received 25 April 2003; returned for revision 4 June 2003; accepted by A. Falus 1 July 2003     

Comparative degree and type of sensitization to common indoor and outdoor allergens in subjects with allergic rhinitis and/or asthma

Background and objectives The determinants of variability in the clinical expression of atopy are still to be documented. The goals of this study were to determine, in subjects with a clinical diagnosis of symptomatic asthma or rhinitis, what is the possible contribution of different types of indoor and outdoor allergens to the development of their disease, by looking at the prevalence and degree of sensitization to these allergens according to age and gender. Subjects and methods We analysed allergy skin prick tests to common airborne indoor and outdoor allergens in 3371 consecutive patients, grouped according to diagnosis of allergic asthma, rhinitis, or both. For each of these three groups, we calculated the prevalence of sensitization to indoor/outdoor allergens, the atopic index (Al), the number of positive responses to allergy skin prick test and the mean wheal diameter (MWD) of these responses. Results The prevalence of atopy and the values of Al and MWD peaked in subjects aged 16 to 25 years, declining afterwards; in subjects ± 18 years old, atopic indices were slightly higher in men than in women. In atopic subjects, the prevalence of sensitization was, in decreasing order: housedust (84.2%), cat hair-epithelium (76.5%), dog hair-dander (63.0%), house dust mite (54.2%), grasses (51.9%), trees (47.2%) and ragweed pollens (44.9%) and finally, moulds (25.4%). Among subjects sensitized only to outdoor allergens (n= 195), 73.8% had a rhinitis, 11.8% had asthma and 14.4% had both diagnoses; for those sensitized only to indoor allergens (n= 710), these values were respeetively 48.6, 24.5 and 26.9%, and for those sensitized to both indoor and outdoor allergens (n= 1793), the comparable values were 55.5, 14.6 and 29.9%. Conclusion These data show that in our population of subjects with respiratory allergic symptoms, indoor allergen sensitization is strongly associated with asthma, while exclusive sensitization to pollens is associated primarily with rhinitis. Sensitization was more prevalent for indoor allergens than for outdoor allergens in all groups determined according to diagnosis or age. Indices of atopy were higher in men in the group ± 18 years old. Prevalence and degree of sensitization were shown to peak in young adults, regardless of the allergen, and to diminish with age. This study stresses the role of indoor allergens in the development of asthma and shows the variability of allergic manifestations according to the type of sensitization.     

Quantitative analysis of IgE antibodies to food and inhalant allergens in 4-year-old children reflects their likelihood of allergic disease

BACKGROUND: It is well established that early diagnosis of allergic disease is warranted. METHODS: In a prospective birth cohort study (BAMSE) 3743 children at 4 years of age were included. Children were classified as having any allergic disease, e.g. asthma, suspected allergic rhinitis (suspAR), eczema or oro-gastro-intestinal symptoms with questionnaire. Blood was obtained from 2612 of these children and analysed for IgE antibodies (ab) towards 14 common food and airborne allergens. RESULTS: Positive IgE ab results were found in 38% of the children with any allergic disease, whereas such IgE ab results were found in 17% among those without any allergic disease. Furthermore, among children with any allergic disease the median summated IgE ab levels were 10.7 kU(A)/l compared with 1.5 kU(A)/l among those without such symptoms. The highest IgE ab levels were found to birch, peanut, cat and horse. When the sum of the IgE-ab levels towards the selected allergens was at least 34 kU(A)/l, or, alternatively, more than four allergen tests were positive, there was a 75% likelihood of identifying the individual with any allergic disease. To identify those with asthma, as well as those with suspAR, a significant interaction was found for the combination of the sum of IgE-ab levels and number of allergens positive at test. For eczema only, the number of positive allergens at test was associated to the likelihood of such disease. CONCLUSIONS: In children, 4 years of age, allergic disease was frequently not associated with the presence of single positive IgE antibody results, whereas increased IgE ab levels were significantly more prevalent among those with allergic disease. Thus, testing a certain profile of airborne and food allergens, and utilizing the sum of the IgE-ab levels in combination with the number of allergens positive at tests, may represent a more efficient diagnostic tool then to use just single positive IgE-ab results.     

Association between response to decongestion testing and sensitizations and allergic inflammation.

BACKGROUND: Rhinomanometry is used to measure nasal airflow, which is frequently impaired in allergic rhinitis (AR). Decongestion testing consists of spraying an intranasal vasoconstrictor drug to evaluate recovery of nasal airflow. OBJECTIVE: To evaluate the relationships among type and number of sensitizations, nasal airflow recovery after topical vasoconstrictor drug use, and allergic inflammation. METHODS: A total of 123 patients (112 men and 11 women; mean +/- SD age, 22.9 +/- 5.7 years) were studied: 40 with perennial AR (PAR), 43 with mixed AR (MAR), and 40 with seasonal AR (SAR). Patients with anatomic nasal defects were excluded. Total symptom scores (including nasal itching, sneezing, rhinorrhea, and nasal obstruction), sensitizations, nasal eosinophils, and cytokines (including interleukin 4 [IL-4], IL-5, and interferon-gamma) were evaluated. Electronic rhinomanometry and decongestion testing were performed in all the patients. RESULTS: After administration of a topical nasal vasoconstrictor agent, mean nasal airflow significantly increased from 471 to 580 mL/s (P < .001). In 12 patients (3 with PAR, 3 with MAR, and 6 with SAR), no increase was shown. Changes from baseline were different in the PAR, MAR, and SAR populations (PAR vs MAR, P < .001; PAR vs SAR, P < .001; and MAR vs SAR, P = .25). Type of sensitization (MAR, PAR, or SAR), concentration of eosinophils, and levels of IL-4, IL-5, and interferon-gamma were associated with nasal airflow recovery of at least 120 mL/s. CONCLUSIONS: This study provides the first evidence of a different response to decongestion testing taking into consideration the type of AR.     

Salsola pollen as a predominant cause of respiratory allergies in Kuwait.

BACKGROUND: Respiratory allergies are common in Kuwait, and the role of certain allergens has been previously documented. OBJECTIVE: To evaluate the results of skin prick tests to a range of allergens that were considered relevant to the vegetation surveys and aerobiological studies performed in Kuwait. METHOD: New patients attending our center during August 2002 to February 2003 with asthma or allergic rhinitis underwent skin prick tests to a battery of allergens. RESULTS: A total of 451 patients aged 5 to 60 years (mean age, 29.5 years) were tested. Of these patients, 403 (89.4%) had a positive test result to at least one allergen and were considered allergic. A total of 76.7% of the allergic patients had a positive reaction to Salsola pollen, with a mean wheal diameter of 8.25 mm (median, 8 mm). Chenopodium album was positive in 57.6% and Bermuda grass was positive in 38.2% of the allergic cases. Indoor allergens seemed to play a lesser role than pollens: Dermatophagoides pteronyssinus was positive in only 37.5%, and American and German cockroaches were positive in 33.2% and 22.3%, respectively. All the allergens other than Salsola elicited a mean wheal diameter of less than 6.25 mm (median, < or = 6 mm). CONCLUSIONS: Indoor allergens seem to play a lesser role in respiratory allergies in Kuwait. Most allergic patients become sensitized to pollens; the strongest and most frequent reaction is from Salsola pollen. Salsola imbricata is found growing extensively in most areas of the country, flowering mainly in autumn, when the most common pollen is of the Chenopod-Amaranth type and when most patients with seasonal allergic rhinitis become symptomatic.     

Circulating level of the platelet-derived CXC chemokine platelet factor 4 in chronic urticaria patients with or without coexistent euthyroid Hashimoto's thyroiditis

The concept of autoimmune aetiology of some cases of chronic urticaria (CU) has been supported by several observation including wheal-and-flare reaction induced by intradermal injection of autologous serum as well as association with other autoimmune diseases, in particular Hashimoto's thyroiditis (HT). It is known that activated platelets may actively participate in immune-inflammatory processes. Therefore, we assessed whether autoimmune phenomenon associated with CU influence the systemic platelet activity measured by circulating level of platelet factor 4 (PF-4). Plasma level of PF-4 was analysed using enzyme-linked immunosorbent assay in twelve women with strong positive response to autologous serum skin test (ASST) suffering from CU, twelve female patients with strong positive ASST suffering from both CU and untreated, HT as well as sixteen healthy women. All the subjects were clinically and biochemically euthyroid. There were no statistically significant differences between the CU patients with or without euthyroid HT and plasma PF-4 level in healthy controls. In patients with both CU and thyroiditis, plasma level of PF-4 did not correlate significantly with the level of antibodies against thyroperoxidase. It seems that circulating level of the platelet-derived chemokine is not increased in CU patients with positive response to ASST, regardless the occurrence of euthyroid HT.     

IgE level and Phadiatop in an elderly population from the PAQUID cohort: relationship to respiratory symptoms and smoking

BACKGROUND: In the last decades in industrialized countries, the increase of life expectancy has resulted in an increase in the population of the elderly. However, little is known about the prevalence of allergies in the elderly population. The aim of the study was to investigate the specific relationship of serum IgE and Phadiatop, with asthma, rhinitis, and smoking in a sample of an elderly population. METHODS: Subjects from the Paquid cohort living in Gironde Department (age 65 years and over) in France were followed up since 1988 (PAQUID cohort). RESULTS: Among the randomized sample of 352 subjects, there were 158 men (45%) and 194 women (55%). The lowest levels of IgE were in subjects with chronic sputum; and in normal subjects (47.1 +/- 56.4 vs 56.2 +/- 73.9, NS). Multiple linear regression was performed with log(10) IgE values as a dependent variable and age, Phadiatop test, smoking, and respiratory symptoms independently in men and in women. In men, a significant relationship was observed between IgE values and Phadiatop test (P < 0.001), asthma history (P = 0.002), and smoking (P = 0.019). CONCLUSIONS: Respiratory allergy is present in persons >65 years of age. There is an association between smoking and IgE level independent of allergic reactivity to common allergens in the elderly.     

Epidemiology of immunoglobulin E levels in a defined population

Age-adjusted geometric mean IgE levels in 621 older subjects were higher in men (26.3 kU/L) than in women (19.1 kU/L), and decreased with age. The higher levels in men were largely a result of a strong positive association with cigarette smoking. Among allergic conditions, a personal history of asthma was associated with the highest IgE levels. In multiple linear regression models in men, cigarette smoking was the single strongest correlate of IgE levels, while a personal history of allergy was the strongest correlate in women. Our results suggest important nonallergic as well as allergic determinants of IgE levels in populations.     

Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis

BACKGROUND: Eosinophilic esophagitis (EE) is an emerging condition where patients commonly present with symptoms of gastroesophageal reflux disease and fail to respond adequately to anti-reflux therapy. Food allergy is currently recognized as the main immunological cause of EE; recent evidence suggests an etiological role for inhalant allergens. The presence of EE appears to be associated with other atopic illnesses. OBJECTIVES: To report the sensitization profile of both food and inhalant allergens in our EE patient cohort in relation to age, and to profile the prevalence of other allergic conditions in patients with EE. METHOD: The study prospectively analyzed allergen sensitization profiles using skin prick tests to common food allergens and inhalant allergens in 45 children with EE. Patch testing to common food allergens was performed on 33 patients in the same cohort. Comorbidity of atopic eczema, asthma, allergic rhinitis and anaphylaxis were obtained from patient history. RESULTS: Younger patients with EE showed more IgE and patch sensitization to foods while older patients showed greater IgE sensitization to inhalant allergens. The prevalence of atopic eczema, allergic rhinitis and asthma was significantly increased in our EE cohort compared with the general Australian population. A total of 24% of our cohort of patients with EE had a history of anaphylaxis. CONCLUSION: In children with EE, the sensitization to inhalant allergens increases with age, particularly after 4 years. Also, specific enquiry about severe food reactions in patients presenting with EE is strongly recommended as it appears this patient group has a high incidence of anaphylaxis.     

Age at bacille Calmette–Guérin vaccination and risk of allergy and asthma

BACKGROUND: It has been proposed that early age at bacille Calmette-Guérin (BCG) vaccination protects against the development of allergy. OBJECTIVE: To study whether early age at BCG vaccination was associated with a decreased risk of atopy, allergic rhinitis, and asthma compared to BCG vaccination at later ages in childhood. METHODS: The occurrence of atopy, allergic rhinitis, and asthma was studied in nearly 2000 women participating in the Danish National Birth Cohort study. Detailed information on age at BCG vaccination (age 0-15 years) was available from school health records. Atopic status was assessed serologically by a specific response to 11 common inhalant allergens using serum samples obtained from the women during the period 1997-2001. Information on allergic rhinitis and asthma was available from telephone interviews. RESULTS: Approximately 85% of the women had been BCG-vaccinated. Age at BCG vaccination was not associated with risk of atopy, allergic rhinitis, or asthma. The odds ratio of atopy, allergic rhinitis, and asthma associated with being vaccinated during the first year of life was 1.05 (95% CI 0.71-1.56), 1.42 (95% CI 0.85-2.36), and 1.71 (95% CI 0.91-3.20), respectively, compared with being vaccinated at the age of 7 years. Adjustment for birth cohort, sibship size, age of the woman's mother at birth, and social class in childhood did not affect the results. CONCLUSION: Our findings suggest that age at BCG vaccination in childhood does not influence the development of allergy or asthma.     

The CX3C chemokine fractalkine in allergic asthma and rhinitis

BACKGROUND: Unlike other chemokines, fractalkine is expressed as a membrane-bound form, mainly on endothelial and epithelial cells, and can be shed as a soluble chemotactic form. Fractalkine can capture leukocytes expressing its receptor (CX(3)CR(1)), including T lymphocytes, rapidly and firmly in an integrin-independent manner. Because of its dual activity, fractalkine plays a major role in the transendothelial and transepithelial migration of leukocytes during inflammation. OBJECTIVE: We sought to study the fractalkine-CX(3)CR(1) axis in patients with allergic airways diseases. METHODS: Plasma fractalkine levels were measured by means of ELISA in 19 control subjects and 55 patients with symptomatic allergic rhinitis, asthma, or both, and CX(3)CR(1) function was studied by using triple-color flow cytometry in circulating T-lymphocyte subpopulations. Segmental allergen challenge was performed in 16 allergic asthmatic patients to analyze fractalkine expression and inflammatory cell recruitment in bronchoalveolar lavage fluid and bronchial biopsy specimens. RESULTS: Compared with control subjects, patients with symptomatic allergic rhinitis and asthmatic patients had increased circulating fractalkine levels, and CX(3)CR(1) function was upregulated in circulating CD4(+) T lymphocytes. Twenty-four hours after segmental allergen challenge, bronchoalveolar lavage fluid soluble fractalkine concentrations increased and correlated with the total number of recruited cells. Bronchial epithelial and endothelial cells expressed high levels of the membrane-bound form of fractalkine before and after challenge. CONCLUSION: Allergic asthma and rhinitis are associated with systemic and bronchial upregulation of the chemotactic axis fractalkine-CX(3)CR(1). This might contribute to the rapid recruitment of circulating CD4(+) T lymphocytes in the airways after allergen stimulation.     

Association of obesity and insulin resistance with asthma and aeroallergen sensitization

Background:  It has been hypothesized that obesity and insulin resistance may play a role in the development of asthma and allergy. The aim of the study was to examine the association of obesity and insulin resistance with asthma and aeroallergen sensitization.
Methods:  Cross-sectional population-based study of 3609 Danish men and women aged 30–60 years. Aeroallergen sensitization was defined as positive levels of specific IgE against a panel of inhalant allergens. Asthma was defined as self-reported physician diagnosed asthma. Allergic asthma was defined as the presence of both asthma and aeroallergen sensitization. The homeostasis model assessment of insulin resistance was used to estimate the degree of insulin resistance. Body mass index, waist-to-hip ratio, and waist circumference were used as measures of obesity. Data were analyzed by multiple logistic regression analyses.
Results:  Obesity was associated with increased risk of aeroallergen sensitization as well as allergic and nonallergic asthma. Insulin resistance was asssociated with aeroallergen sensitization and allergic asthma, but not nonallergic asthma. The associations of obesity with aeroallegen sensitization and allergic asthma became nonsignificant after adjustment for insulin resistance, whereas the association of obesity with nonallergic asthma was unaffected. No sex-differences were observed.
Conclusion:  Obesity may be related to an increased risk of aeroallergen sensitization and allergic asthma through mechanisms also involved in the development of insulin resistance.     

The changes in plasma beta-thromboglobulin (beta-TG), platelet factor 4 (PF4) and thromboxane B2 (TXB2) after a bronchial provocation test (BPT) with house dust (HD) allergen]

In order to investigate the role of platelets in allergic asthma, the time related changes in plasma levels of beta-TG, PF4 and TXB2 were evaluated following BPT with HD in 19 patients with bronchial asthma who were positive in skin test and RAST to HD. The results obtained were as follows. 1) Plasma beta-TG and PF4 levels tended to increase following BPT with HD at the time of immediate asthmatic response (IAR) in patients showing IAR alone. 2) Plasma beta-TG and PF4 levels increased significantly (p less than 0.05) at IAR and tended to increase at the time of late asthmatic response (LAR) in patients showing a dual asthmatic response (DAR). 3) The levels of plasma TXB2 in patients showing IAR alone significantly increased at IAR (p less than 0.05) and gradually decreased and the levels of plasma TXB2 in patients showing a DAR increased in each period of IAR, 3 hr after BPT and LAR, and the peak of TXB2 was observed in 3 hours after BPT. 4) These results suggest that platelets are activated at IAR and there was also a possible activation in platelets at LAR.     

Atopic profile of inner-city asthma with a comparative analysis on the cockroach-sensitive and ragweed-sensitive subgroups

Background: Inner-city asthma is well known for its high risk of mortality. To better understand urban asthma, we examined clinical characteristics and aeroallergen sensitivities of 592 of 680 consecutive urban Chicago residents with asthma.Methods: A total of 227 male and 453 female subjects who met the criteria for the study were registered. A comprehensive clinical evaluation was followed by allergy skin testing (prick and intradermal testing) with. 10 groupings (5 indoor and 5 outdoor) of common aeroallergens. Serum total IgE and selective antigen-specific IgE levels, including cockroach-specific IgE, were routinely measured. A total of 592 (196 male and 396 female) subjects with an average age of 35 years were, skin tested_ The average duration of asthma was 12.6 years, and 31 % of the population was receiving corticosteroids.Results: Aeroallergen sensitivity was noted in 85%, and 94 subjects (15%) were nonallergic. House dust sensitivity (76%) was most prevalent, distantly followed by sensitivity to cockroach (48%), ragweed (4_5%), other weeds (42%), cat (40%), and dust mite (24%). The average number o f aeroallergen sensitivities detected was 4 of 10 groupings of both indoor and outdoor allergens. Twenty percent of subjects were allergic to only indoor allergens, whereas 4% were allergic to outdoor allergens only. Serum IgE was 245 ± 17.3 IU/ml (geometric mean + SEM), and 74% of 444 serum samples assayed showed IgE antibody levels greater than or equal to 100 IU/mI. A cockroach-sensitive subgroup (283 subjects) had longer duration of asthma (p, < 0.0001) and fewer additional aeroallergen sensitivities (p < 0.0001) than the ragweed-sensitive subgroup (264 subjects).Conclusion: The results indicate that a great majority (85%) of inner-city Chicago residents with asthma have atopic asthma, as demonstrated by highly elevated IgE levels and multiple aeroallergen sensitivities. Sensitivity to indoor allergens is more prevalent than sensitivity to outdoor allergens. The subjects with cockroach-sensitive asthma appear to be a distinctive subgroup characterized by chronicity, and elevated serum IgE antibody levels with fewer aeroallergen skin test sensitivities.     

Nasal mucosal expression of nitric oxide synthases in patients with allergic rhinitis and its relation to asthma.

BACKGROUND: Nitric oxide (NO) has contradictory roles in the pathophysiology of allergic inflammation in both allergic rhinitis (AR) and asthma. Small amounts of NO produced by constitutive NO synthase (NOS) is anti-inflammatory, whereas large amounts produced by inducible NOS (iNOS) are proinflammatory. OBJECTIVE: To investigate the difference in constitutive endothelial NOS (eNOS) and iNOS expression in nonallergic and allergic mucosa and the possible relation of this to the coexistence of asthma in seasonal AR. METHODS: Seventeen patients (10 women and 7 men) with seasonal AR and 9 nonallergic patients (5 women and 4 men) with nasal septum deviation were enrolled. Inferior turbinate nasal biopsy specimens were obtained in all. Levels of eNOS and iNOS expressed as immunohistochemical scores (HSCOREs) were determined immunohistochemically from the specimens. RESULTS: The mean +/- SD HSCOREs for eNOS in patients with seasonal AR were not significantly different from those of the nonallergic controls (1.85 +/- 0.78 vs 1.63 +/- 0.54; P = .12). On the other hand, the mean +/- SD HSCOREs for iNOS were significantly higher in patients with seasonal AR (1.75 +/- 0.75 vs 0.71 +/- 0.6; P = .004). Furthermore, although eNOS expression was not different between seasonal AR patients with and without asthma, the mean +/- SD HSCOREs for iNOS were significantly higher in the patients with asthma (1.93 +/- 0.78 vs 1.65 +/- 0.55; P = .01). CONCLUSION: Increased expression of iNOS might have a role in the development of allergic inflammation in upper and lower airways and in comorbidity of AR and asthma.     

Correlation of nasal inflammation and nasal airflow with forced expiratory volume in 1 second in patients with perennial allergic rhinitis and asthma.

BACKGROUND: Allergic rhinitis and asthma are frequently associated and are characterized by TH2-dependent inflammation. Nasal and bronchial obstruction largely depend on allergic inflammation. OBJECTIVE: To evaluate the relationships among nasal eosinophil counts, interleukin 4 (IL-4) and interferon-gamma (IFN-gamma) levels, nasal airflow, and forced expiratory volume in 1 second (FEV1) in patients with perennial allergic rhinitis and asthma. METHODS: Eight men and 7 women (mean +/- SD age, 24.8 +/- 4.7 years) with perennial allergic rhinitis and asthma were evaluated. All 15 patients had a moderate-to-severe grade of nasal obstruction. Total symptom score, rhinomanometry, nasal lavage, nasal scraping, and spirometry were evaluated in all patients. Eosinophils were counted using conventional staining; IL-4 and IFN-gamma levels were measured by immunoassay in fluids recovered from nasal lavage. RESULTS: Significant positive relationships were demonstrated between eosinophil infiltration and IL-4 levels, nasal airflow and IFN-gamma levels, FEV1 and IFN-gamma levels, and nasal airflow and FEV1 (P < .001 for all). Significant negative relationships were demonstrated between eosinophil infiltration and IFN-gamma levels, IL-4 and IFN-gamma levels, eosinophil infiltration and nasal airflow, IL-4 values and nasal airflow, nasal eosinophil counts and FEV1, and IL-4 values and FEV1 (P < .001 for all). CONCLUSIONS: There is a close association between TH2 cytokines and eosinophil infiltration in the nose. There is also clear evidence concerning the relationships among eosinophil infiltration, IL-4 and IFN-gamma levels, and nasal airflow. Nasal eosinophil, IL-4, and IFN-gamma levels correlate with FEV1. Finally, nasal airflow is related to FEV1. These findings constitute the first evidence of a relationship between TH2-related nasal inflammation and nasal and bronchial airflow in patients with perennial allergic rhinitis and asthma.     

Childhood asthma and early life exposure to indoor allergens,endotoxin and β(1,3)‐glucans

Background Divergent results have been reported regarding early life exposure to indoor environmental agents and the risk of asthma and allergic sensitization later in life. Objective To assess whether early exposure to indoor allergens, β(1,3)‐glucans and endotoxin modifies the risk of allergic diseases at 10 years of age. Methods The concentrations of mite, cat and dog allergens, endotoxin and β(1,3)‐glucans were determined in dust from the homes of 260 two‐year‐old children with lung function measured at birth (tidal flow volume loops) in the Environment and Childhood Asthma study in Oslo. At 10 years, the health status was assessed in a follow‐up study including a structured interview of the parents and an extended clinical examination. Results Cat and dog keeping at 2 years of age was reported in 6.5% and 5.5% of the families, respectively. Mite allergens were detected in only 4/260 dust samples. The adjusted odds ratio for asthma at age 10 was 1.20 (95% confidence interval: 1.01–1.43) and 1.22 (1.02–1.46) for bronchial hyperresponsiveness (BHR) per 10 μg/g dust increase in cat allergen exposure at 2 years of age. No association was seen with allergic sensitization. Moreover, endotoxin and β(1,3)‐glucan exposure did not modify the risk of asthma or allergic sensitization. None of the measured environmental factors were associated with lung function at 10 years of age or a relative change in lung function from birth. Conclusion In a community with a low prevalence of pet keeping and low mite allergen levels, exposure to cat allergens early in life increased the risk of late childhood asthma and BHR, but not the risk of allergic sensitization. No risk modification was seen for dog allergens, endotoxin and β(1,3)‐glucans. Cite this as: R. J. Bertelsen, K. C. Lødrup CarlsenK.‐H. Carlsen, B. Granum, G. Doekes, G. Håland, P. Mowinckel and M. Løvik, Clinical & Experimental Allergy, 2010 (40) 307– 316.     

Circulating ICAM-1 levels in bronchial asthma and the effect of inhaled corticosteroids.

BACKGROUND: Even mild asthma has an inflammatory component. Intercellular adhesion molecule-1 (ICAM-1) plays an important role in inflammation. Higher levels of circulating ICAM-1 (cICAM-1) in sera may reflect the upregulation of ICAM-1 expression in allergic inflammation. OBJECTIVE: The aim of this study was to assess cICAM-1 levels in children with atopic bronchial asthma and to determine the effects of inhaled glucocorticoids on cICAM-1 levels. METHODS: The study group consisted of 25 children with moderate atopic bronchial asthma with a mean age of 9.9 +/- 4.2 years, and the control group consisted of 18 healthy children with a mean age of 9.6 +/- 2.6 years. Serum cICAM-1 levels and pulmonary function tests were measured. The patients were treated 2 months with inhaled budesonide 400 to 800 microg (mean 440 microg) per day. After this treatment, cICAM-1 levels and pulmonary function tests were compared with pretreatment levels. The pretreatment cICAM-1 values were compared with healthy control group. RESULTS: The initial cICAM-1 levels of the patient group were significantly higher than the cICAM-1 levels of the control group (P = .001). The post-treatment cICAM-1 levels of the patient group were significantly lower than the pretreatment values (P = .007). Pulmonary function test results (FEV1, FEF25-75, and PEFR) rose significantly with the treatment in patients (P < .05). CONCLUSION: This study revealed the presence of inflammation in children with even moderate atopic asthma as reflected with elevated levels of cICAM-1 levels, which decreased following corticosteroid treatment as a result of decreased inflammation.