Allergic Adults Research Articles

Modulation of immune mediators with MQT-based immunotherapy

Assess immune and clinical changes with immunotherapy based on modified quantitative testing (MQT). Immunotherapy promotes immunomodulation that occurs over several years. Quantitative testing offers the advantage of initiating immunotherapy with robust antigen concentrations. This study assessed whether changes in immune mediators and allergy symptoms occur rapidly using quantitative techniques. Sixteen allergic adults were tested using MQT. Subjects had serum drawn for immunoglobulins E and G4 (IgE, IgG4) to 3 antigens, Der p1, Der f1, and Fel d1, and for interleukins IL-1beta, IL-2, IL-4, IL-5, IL-10, IL-12, and IL-13, and IL-1 receptor antagonist (IL-1RA). Subjects also completed the Sino-Nasal Outcome Test-20 (SNOT-20), the Allergy Outcome Scale (AOS), and the Rhinosinusitis Disability Index (RSDI). They underwent MQT-based immunotherapy and completed outcome measures again at 6 and 12 weeks. Nine subjects completed the study. Analysis demonstrated significant increases in IgG4 levels to all antigens, significant decreases in serum levels of IL-1beta and IL-5, and significant increases in levels of IL-1RA. Improvement was also noted in AOS and RSDI subscales. Immunotherapy based on MQT demonstrates significant changes in immunoglobulin and cytokine levels by 12 weeks following initiation. In addition, improvement in symptom and quality-of-life measures occurs by 12 weeks. These findings support the rapid onset of clinical effects with MQT-based treatment of inhalant allergy. C-4.

Tuberculosis and atopy: A study in an endemic area

Atopy is expected to be less frequent and milder in patients with early exposure to bacterial infections because of regulatory immune mechanisms. The definition of the hygiene hypothesis and most of the related studies have been performed in children. In a population where both tuberculosis (tbc) and atopy are prevalent, we investigated skin test results to allergens in adults with tbc. A standard panel of skin-prick tests (SPTs) was applied to patients with active (n = 21) or inactive (n = 72) tbc and age-matched healthy control subjects (n = 76) from the same environment. Patients also had tuberculin skin tests applied twice at 8 weeks' interval. Patients with inactive tbc had a higher rate of allergic symptoms than those with active tbc (P < 0.01). SPTs were less frequently positive in tbc patients than in control subjects (P < 0.005). Tuberculin skin reactions were not related to SPTs positivity. Our results suggest allergic skin test reactions may be suppressed in patients with tbc: the interpretation of SPTs should be made accordingly.

Seafood Allergic Reactions in Restaurants

RATIONALE: Seafood allergy is estimated to affect 2.3% of the US population; restaurant reactions are common, but little is known about the circumstances. METHODS: A structured questionnaire was administered to a random sample selected from 415 registrants reporting restaurant reactions in the National Seafood Allergy Registry (n=1000). RESULTS: Participants (125 registrants describing 182 reactions [42% first lifetime reactions]) included 58% allergic adults and 42% surrogates for children. Allergies included: shellfish (60%), fish (17%), or both (22%). The most frequent restaurant types were seafood (23%) and Asian (18%). Reactions were attributed to oral ingestion (90%), skin contact (4%) or inhalation (6%). Symptom distribution was: gastrointestinal (67%), cutaneous (61%), respiratory (47%), and cardiovascular (9.4%). Treatment was given for 70% of reactions (epinephrine-17%, antihistamines-81%). Only 21% with a known allergy disclosed their allergy to the restaurant. Mistakes were attributed to cross-contact (same oil, grill or pan) in 34% of reactions. It was common (61%) for persons with a prior reaction to re-order seafood. A subsample who did so indicated their reasons: allergy not clearly diagnosed (64%), attributed to a different category of seafood (23%), or curiosity about persistence (13%). Restaurants were rarely (19%) notified about reactions. Participants did not reduce their frequency of restaurant dining, but 95% indicate they ask more questions or avoid particular types of foods/restaurants. CONCLUSIONS: Seafood restaurant reactions can be attributed to poor communication, misunderstanding of the allergy by those affected, and cross-contact in preparation. These problems could be rectified through education of patients and the restaurant industry.

Evaluating the Allergic Risk of Genetically Modified Soybean

Genetically modified (GM) soybean (carrying the EPSPS transgene) is the most common GM food in Korea. In order to assess whether genetic modification increases the allergenic risk of soybeans, the allergenicity and IgE-reactive components of wild-type and GM soybean extracts were compared in allergic adults who had been sensitized to soybeans. We enrolled 1,716 adult allergy patients and 40 healthy, non-atopic controls. Skin prick tests and IgE enzyme linked immunosorbent assays (ELISAs) were performed using wild-type and GM soybean extracts, along with other common inhaled allergens. The specificities of serum IgE antibodies from allergic patients and the identities of the IgE-reactive components of the soybean extracts were compared using ELISA inhibition testing, 2-dimensional gel electrophoresis, and IgE immunoblotting. To evaluate the effects of digestive enzymes and heat treatment, the soybean extracts were heated or pre- incubated with or without simulated gastric and intestinal fluids. The IgE sensitization rates to wild-type and GM soybeans were identical (3.8% of allergic adults), and circulating IgE antibodies specific for the two extracts were comparable. The results of the ELISA inhibition test, SDS-PAGE, and IgE immunoblotting showed a similar composition of IgE-binding components within the wild-type and GM extracts, which was confirmed using two-dimensional gel electrophoresis, IgE immunoblotting, and amino acid sequencing. None of the subjects had a positive response to purified EPSPS protein in the skin prick test, ELISA, or IgE immunoblot analysis. These findings suggest that the IgE sensitization rate to GM soybean extracts is identical to that of wild-type soybean extracts in adult allergy patients. In addition, based on both in vivo and in vitro methods, the allergenicity of wild type and GM soybean extracts was identical.

Sensitization to Common Allergens in Adults with Asthma

To estimate the prevalence of atopy (ie, allergen sensitization) in a sample of adult asthma outpatients. Population consisted of a total of 218 patients, 18 to 55 years of age, who were currently receiving care for asthma; and 13 physicians, whose specialties were Family Practice, Allergy, or Pulmonology and who were providing care to at least 10 to 15 asthma patients weekly. Patients provided a blood sample for quantification of total and allergen-specific IgE. Outcomes were the proportion of patients with atopy and the proportions of patients with elevated serum IgE specific to each of 8 specific common allergens. The patients' mean age was 42 years, and 74% were women; 68% of patients met the study definition of atopy. Total serum IgE > or = 114 kU/L was observed in 48% of patients, and 59% had elevated levels of IgE specific to one or more of 8 common allergens. The majority of adult asthma outpatients had evidence of atopy and most were sensitive to a specific identifiable allergen. Awareness of the high prevalence of atopy among asthma patients might improve patient management.

562: The Association between Obesity and Asthma is Stronger in Non-Allergic than Allergic Adults

562: The Association between Obesity and Asthma is Stronger in Non-Allergic than Allergic Adults

Increased expression of plasma and cell surface co-stimulatory molecules CTLA-4, CD28 and CD86 in adult patients with allergic asthma

The co-stimulatory interactions of the B7 family molecules CD80 and CD86 on antigen-presenting cells, together with their T cell counter receptors CD28 and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4), modulate T lymphocyte-mediated immune responses in a reciprocal manner. To investigate whether there is altered expression and the clinical significance of soluble co-stimulatory molecules in asthmatic patients, plasma concentrations of sCTLA-4, sCD28, sCD80 and sCD86 in 51 adult allergic asthmatic adults with or without steroid treatment, and 35 sex- and age-matched control subjects were measured by enzyme-linked immunosorbent assay (ELISA). Cell surface expression of CTLA-4 and CD28 on peripheral blood mononuclear cells (PBMC) were analysed by flow cytometry. Results showed that the plasma sCTLA-4 concentration was significantly higher in all asthmatic patients while sCD28 and sCD86 concentrations were significantly higher in steroid and non-steroid treated asthmatic patients, respectively, compared with control subjects (all P < 0.01). Significantly increased cell surface expression of CD28 but not CTLA-4 on PBMC was found in asthmatic patients compared with controls (P < 0.05). The plasma concentration and cell surface expression of CTLA-4 were found to exhibit positive and significant correlations with those of CD28 (both P < 0.05). Serum total IgE concentration correlated positively and significantly with sCTLA-4 and sCD28 concentrations in allergic asthmatic patients (both P < 0.05). The increased expression of these soluble co-stimulatory molecules may reflect the dysregulation of T cell activation, thereby contributing to the immunopathogenesis of allergic asthma.

Fruit and vegetable allergy in children

Rationale Fruit and vegetable allergy is common in pollen allergic adults. We sought to characterize plant food allergy in children. Methods Chart reviews of children with fruit/vegetable allergy evaluated at Mount Sinai Allergy Clinic from 2000 to 2002 and telephone interviews were performed. Results Ninety five patients were identified, and 69 were enrolled. Participants were median 11 years old (range, infancy to 18), reported onset of fruit/vegetable allergy at a median age of 5 years (range, infancy to 16) and reacted to a median of 5 fruits/vegetables (range, 1 to 20). A total of 383 fruit/vegetable reactions were reported; 52% occurred to foods typically associated with birch (apple, carrot, peach) and 33% with ragweed pollen (cantaloupe, banana, honeydew). Symptoms were predominantly limited to oropharyngeal mucosa but progression was reported in 4 children; 2 developed respiratory or cardiovascular reactions to carrots, 1 had generalized urticaria to carrot, broccoli and cauliflower, and 1 developed severe throat angioedema to tomato. Additionally, 9 children reported 14 initial systemic reactions to 11 foods, 5 of which do not have a well established cross-reactivity with pollen. Generalized urticaria occurred in 10 reactions, 1 also associated with cough. Respiratory and cardiovascular symptoms occurred in 4 reactions, one of which was caused by carrot. Conclusions Fruit/vegetable allergy in children is similar to that in adults; symptoms are generally mild and associated with pollen-rhinitis. Systemic reactions occur rarely and may be more common with carrot and with foods not classically cross-reactive with pollen.

The etiology of Kawasaki disease: does intense release of pollen induce pollinosis in constitutionally allergic adults, while constitutionally allergic infants develop Kawasaki disease?

Kawasaki disease (KD, muco-cutaneous lymph node syndrome, MCLS) is an acute, febrile disease of nursing infants that Tomisaku Kawasaki first reported in Japan in 1962. There are about 190,000 patients in Japan. On the etiology of KD, it is still a disease of unknown origin, even more than 40 years have passed since Kawasaki’s first finding. Nationwide surveys on KD, which have been done in Japan from 1970, revealed that there were three times greater, large-scale occurrences of KD in 1979–1986. This information provided AA with a clue for the elucidation of the etiology of KD. Yozo Saito made the first report about allergic rhinitis/conjunctivitis (pollinosis) caused by Japanese cedar pollen in 1963. Thus, these two diseases were found almost during the same period of time in Japan. The numbers of pollen releases of Japanese cedar pollen and other pollens have also been observed at the sites of the various regions in Japan for each season, in every year from as early as 1965. After drawing graphs of these data on the level of pollen releases of eight sites, we compared those with a graph of the annual numbers of occurrence of KD patients; we found a correlation between the peaks of pollen release not observed before then and the peaks of KD occurrences. Therefore, we think that this evidence suggests a likely strong link between the occurrence of KD and pollen releases, which may provide a basis for solving the etiology of KD.

THE PREVALENCE AND DIAGNOSTIC VALUE OF SPECIFIC IgE ANTIBODIES TO INHALANT, ANIMAL AND PLANT FOOD, AND FICUS ALLERGENS IN PATIENTS WITH NATURAL RUBBER LATEX ALLERGY.

Background: It is well recognised that natural rubber latex allergy can be associated with serological crossreactivity to plant allergens, especially tropical fruits and Ficus. In contrast, data on the frequency and clinical value of specific IgE antibodies against these allergens remain rare. In addition, little is known about the prevalence and diagnostic value of specific IgE antibodies to classical inhalant and animal allergens in NRL allergic patients.Objective: The purpose of this study was to investigate the prevalence, the sensitivity, and the specificity of these different specific IgE antibodies in patients suffering from NRL allergy.Methods: Serum samples of 42 NRL allergic adults were investigated. All had a history of NRL allergy confirmed by a positive skin test for latex and a positive latex-specific IgE. Samples were analysed for IgE antibodies against 9 plant food allergens (avocado, banana, chestnut, fig, kiwi, papaya, peanut, pineapple and tomato) and Ficus benjamina. A specific IgE quantification for 3 animal food allergens (codfish, cow’s milk, egg’s white) and 8 common inhalant allergens (Dermatophagoïdes pteronyssinus, birch pollen, timothy grass pollen, mugwort pollen, cat and dog epithelium, Aspergillus fumigatus and Cladosporium herbarum) was also performed. Because double blind placebo-controlled challenges could not be considered, for ethical reasons, patient’s food allergy or immediate hypersensitivity for Ficus and inhalant allergens was documented by a standardised questionnaire. Diagnosis of atopy was based on a relevant history and the presence of a specific IgE antibody to at least one classical inhalant allergen. For some IgE determinations presence or absence of cross-reactivity was investigated by CAPinhibition tests.Results: A specific IgE antibody to at least one of the investigated inhalant and animal food allergens was found in respectively 76% and 12% of the serum samples. A plant food-specific IgE antibody was observed in 88% of the serum samples, most frequently to papaya (71%) and least frequently to kiwi (17%). Twentynine percent of the serum samples contained Ficus-IgE. According to the questionnaire and the threshold of 0.35 kUa/L, sensitivity of the plant food IgE antibodies varied between 0% for papaya and 73% for avocado. Specificity varied between 28% for papaya and 91% for kiwi. For Ficus-IgE sensitivity was 20% and specificity 70%. Conclusions: For inhalant and animal food allergens sensitivity and specificity of the IgE quantification correlated generally well with the values obtained in non- NRL allergic adults. Determination of specific IgE to the investigated plant foods and Ficus was not always a sensitive neither a specific test to establish the clinical diagnosis of this allergy.

The effect of specific immunotherapy on T-cell receptor repertoire in patients with allergy to house-dust mite.

The precise mechanism of specific immunotherapy (SIT), long used for treating allergic diseases, remains undefined. SIT was shown to act by modifying the immune response of T lymphocytes to antigens. We examined the effect of SIT on the expression and use V-alpha, -beta, -gamma and -delta chains of T-cell receptors (TCR) in patients allergic to house-dust mite. Peripheral venous blood was taken for lymphocyte TCR analysis from 10 house-dust mite (HDM) allergic adults before initiating SIT and 6 months after initiating the treatment. Twelve similarly allergic patients without SIT served as controls. TCR chains were identified by fluorescence-activated cell sorter (FACS) using the following monoclonal antibodies: CD3, CD14, CD8, pan alpha-beta, pan gamma-delta, V-alpha2, V-alpha12.1, V-beta5a, V-beta5b, V-beta5c, V-beta8a, V-beta8b, V-beta3.1, V-beta13, V-beta12, V-beta6.7, V-delta1, V-delta2, V-gamma9, and V-gamma4. Analyzed before and 6 months after SIT initiation, lymphocyte TCR showed significantly increased V-beta5b, V-beta12 and V-alpha12.1 values compared to controls (without significant changes in other markers). SIT caused selective expansion of certain V-beta- and V-alpha-expressing T cells in patients allergic to HDM. Our results support the notion that the effect of SIT in patients with allergic rhinitis may be achieved by modifying the T lymphocyte response through the modulation of TCR usage.

Intolerance to nonsteroidal anti-inflammatory drugs might precede by years the onset of chronic urticaria

Background: Recent studies have found that most otherwise normal subjects with a history of acute urticaria induced by several nonsteroidal anti-inflammatory drugs (NSAIDs) show a wheal-and-flare reaction on intradermal injection of autologous serum. This phenomenon has been previously observed in patients with chronic urticaria (CU) and suggests a possible common background in CU and NSAID-induced urticaria. A relationship between these 2 conditions is further suggested by the fact that up to 30% of patients with CU have a worsening of their skin disorders after the ingestion of chemically unrelated NSAIDs. Objective: I sought to assess whether otherwise normal subjects with multiple or single NSAID intolerance show a propensity to have CU. Methods: Two hundred eighty otherwise normal patients with an unequivocal history of acute urticaria induced by NSAIDs seen during the last 10 years were studied. On the basis of both clinical history and oral challenge tests with at least 2 alternative NSAIDs, the patients were classified as having single or multiple NSAID intolerance. All the patients were re-evaluated within the end of 2002, 1 to 10 years after the first visit, to assess the onset of CU. One hundred allergic adults without a history of CU and of drug allergy followed up for 1 to 10 years were used as control subjects. Results: One hundred fifty-nine and 121 patients were finally considered as having single or multiple NSAID intolerance, respectively. At the follow-up visit, 93 (33%) of 280 patients had CU. The prevalence of CU was very similar in subjects with single or multiple NSAID intolerance (48/159 [30%] vs 45/121 [37%], respectively; P = not significant). Only 1 (1%) of 100 atopic control subjects had CU during the follow-up period (P < .001). Among single NSAID reactors, patients who had CU had a significantly higher prevalence of intolerance to aspirin than those who did not have CU (36/48 [75%] vs 41/111 [37%], P < .001), whereas the latter had a markedly higher prevalence of intolerance to pyrazolone drugs (52/111 [47%] vs 10/48 [21%], P < .01). Altogether, only 12 (15%) of 82 patients intolerant to drugs other than aspirin versus 36 (47%) of 77 aspirin reactors had CU (P < .001). Conclusion: NSAID intolerance might precede the onset of CU by years. Both multiple and single NSAID reactors with a history of aspirin-induced urticaria seem at higher risk for CU than patients with a history of single intolerance to NSAIDs other than aspirin. (J Allergy Clin Immunol 2003;111:1095-8.)

Current mite, cat, and dog allergen exposure, pet ownership, and sensitization to inhalant allergens in adults

Background: Simultaneous exposure to more than one allergen might modify the effect of individual allergens. Objective: The purpose of this study was to investigate the effect of current exposures to mite, cat, and dog allergen and pet ownership on sensitization in adults. Methods: Questionnaires, skin tests, and home visits (Der p 1, Fel d 1, and Can f 1, ELISA; mattresses, living room floors) were performed in 2502 adults. Allergen exposure was treated as a continuous variable and divided into quartiles. To investigate the interaction between allergens, quartiles for 3 allergens were added, creating arbitrary combined exposure categories. Results: In the univariate analysis, mite sensitization was associated with Der p 1 in mattresses (odds ratio [OR], 1.10; 95% CI, 1.01 to 1.19; P = .03) and with Can f 1 in living room floors (OR, 1.08; 95% CI, 1.00 to 1.17; P =.05). In a multivariate regression analysis, Der p 1 in mattresses remained an independent associate of mite sensitization (OR, 1.12; 95% CI, 1.02 to 1.23; P = .03) and pollen sensitization (OR, 1.23; 95% CI, 1.11 to 1.36; P = .0001). The proportion of subjects sensitized to mite increased significantly with the increasing combined exposure categories (P < .0001). The highest prevalence of sensitization to cat and dog was in the medium combined exposure categories. Cat ownership was associated with a reduced prevalence of sensitization to cats (P = .002) and a reduced prevalence of sensitization to dog (P = .003) but had no effect on sensitization to mite and pollen. Conclusions: Sensitization to dust mites increased with the increasing combined exposure. Cat ownership was associated with a lower prevalence of sensitization to cat and dog but not to mite and grass pollen. (J Allergy Clin Immunol 2003;111:402-7.)

The effect of mite allergen immunotherapy on nasal nitric oxide in allergic adults

The effect of mite allergen immunotherapy on nasal nitric oxide in allergic adults

Measurement of changes in mRNA for IL-5 in noninvasive scrapings of nasal epithelium taken from patients undergoing nasal allergen challenge

Nasal allergen challenge of patients with allergic rhinitis results in increased numbers of inflammatory cells and increased production of pro-inflammatory cytokines including interleukin 5 (IL-5). We report a sensitive, noninvasive method to measure changes in the amount of mRNA for IL-5 in nasal epithelium and have used this method to detect alterations of IL-5 mRNA from patients undergoing a nasal allergen challenge. Ten grass or ragweed allergic adults were challenged out of season with appropriate pollen extracts at sufficient dose to give a rhinitis total symptom score of 5 on a scale of 12. After allergen exposure, symptoms were recorded hourly. At 0, 3, and 6 h after allergen exposure, secreted proteins were collected on filter paper strips and two superficial scrapings of nasal epithelium were obtained. The scrapings of epithelium were immediately immersed in 100 μl of RNAlater® (Ambion, Austin, TX) and stored at 4 °C for up to 1 month without loss of RNA quality. Total RNA was isolated and RT-PCR was performed. cDNA for IL-5 was then measured by real-time fluorescence quantitative PCR with Pre-Developed TaqMan® Assay Reagents (PE Biosystems, Foster City, CA). Sufficient RNA was isolated from eight subjects to measure IL-5 mRNA. Data were normalized for content of ribosomal RNA. The relative amount of cDNA for IL-5 was calculated by comparison with internal standards prepared from phytohemagluttinin-stimulated peripheral blood mononuclear cells. Messenger RNA for IL-5 was increased 8.7±2.7-fold at 3 h ( p<0.01) and 39.5±20.9-fold at 6 h ( p<0.01). Increased IL-5 mRNA levels at 6 h closely correlate with total symptom scores at 6 h ( r=0.88; p=0.007). IL-5 protein was measured by ELISA in eluates from the filter papers. At 6 h, there was increased IL-5 protein (7.7±2.8 ng/ml) compared with time zero (1.8±0.5 ng/ml) ( p=0.02). The levels of IL-5 protein did not correlate significantly with the symptoms score or with changes in the levels of IL-5 protein with IL-5 mRNA. These data show that changes in IL-5 mRNA in patients with allergic rhinitis undergoing an allergen challenge correlate with total symptom scores better than changes in IL-5 protein eluted from filter paper. Furthermore, these changes can be measured quantitatively in very small amounts of tissue.

Variations of nasal nitric oxide in a subject with allergic rhinitis: A longitudinal study

Purpose: Nitric oxide (NO) in the exhaled air is mainly produced by the upper respiratory airway mucosa, and the output of NO has been found to differ from normal in sinonasal disease. In allergic rhinitis (AR) nasal NO output (VNO) has been reported to increase compared with healthy individuals. The purpose of this study was to observe daily variations in VNO in a subject with AR and to investigate the effect of environmental factors on VNO. Material and Methods: We measured VNO daily in an individual with AR over a period of 5½ months to determine the variability of VNO from day to day. We used a 41-year-old, nonsmoking volunteer with AR as our subject to investigate the relationship between VNO and some environmental factors likely to affect VNO. The correlation between VNO and nasal symptom scores was also investigated. Daily ambient NO concentrations, humidity, atmospheric pressure, and atmospheric grass pollen concentrations were recorded along with morning nasal NO measurements. At each measurement session, online NO measurements were done from both nostrils at 5 L/min constant transnasal flow. During the study the subject had a short period of a cold and a short period of purulent rhinitis and started using a nasal steroid spray at the end of the study. Results: VNO levels for our subject were higher than previously published values for normal and allergic adults. There was an increase in VNO (the highest value throughout the study) in the prodromal period of the cold and a significant decrease (the lowest values throughout the study) during the cold. Change during the purulent rhinitis was less remarkable than change during the cold. Conclusion: No correlations between environmental conditions (humidity, atmospheric pressure, pollen count) and VNO were found. VNO changes were also independent of specific and cumulative nasal symptom scores. (Am J Otolaryngol 2002;23:191-195. Copyright 2002, Elsevier Science (USA). All rights reserved.)

Development of new IgE specificities to allergenic components in birch pollen extract during specific immunotherapy studied with immunoblotting and Pharmacia CAP System™

New IgE sensitizations to proteins in allergen extracts have been shown to occur during allergen-specific immunotherapy (IT). However little is known about the kinetics of the changes in antibody reactivities. Twenty-four allergic children and adults were treated with birch pollen rush IT (RIT). Fifteen matched patients served as allergic controls. Sera were obtained at regular intervals for up to three years and analyzed with immunoblotting and Pharmacia CAP System with recombinant (r) birch pollen allergens (rBet v 1, rBet v 2, and rBet v 4). All birch-allergic patients had specific IgE to the major birch pollen allergen Bet v 1, but only three had IgE to rBet v 2 and/or rBet v 4 at the beginning of the study. New IgE sensitizations developed in 65% of the birch RIT-treated patients when studied by immunoblotting. Twenty-nine percent of the patients developed new sensitizations to rBet v 2 and/or rBet v 4 during RIT as measured by Pharmacia CAP System. Generally, new specific IgE reactivities occurred after at least one year of RIT, and only at low levels (< 1 kUA/l). Sensitization to additional allergenic pollen components frequently occurs during prolonged birch RIT. However, the IgE levels are low and the clinical relevance is not known.

What should we tell allergic families about pets?

What should we tell allergic families about pets?

Relationships Between Environmental Factors and Lung Function of Asthmatic Subjects in South East Queensland, Australia

Few panel studies have investigated the relationships between air pollutants and air spora and lung function change in asthmatic subjects. This article examines the association of outdoor air pollutant concentrations and air spora with the decrease in lung function (measured by morning peak expiratory flow) of two groups of asthmatic subjects in the subtropical environment of South East Queensland, Australia. Lung function responses were stratified by age, allergy status, and location, and seasonal effects were examined. Allergy status and age were found to be important, with air pollutants such as ozone and particles associated with decreases in lung function in allergic individuals older than 15 years. Fungal spore counts were strongly associated with a decrease in lung function in allergic adults, especially in those over 54 years, only in seasons when these air spora peak. Analysis for the entire study period indicates that the effect of ozone on peak expiratory flow in the allergic group can sometimes be confounded by air spora effects, indicating that in a subtropical climate the impact of ozone on asthma severity can be accurately estimated only when the confounding effects of air spora are included.

The Editors’ Choice

The Editors’ Choice