Allergic Respiratory Diseases Research Articles

DEP-induced ZEB2 promotes nasal polyp formation via epithelial-to-mesenchymal transition

Diesel exhaust particles (DEPs) are associated with the prevalence and exacerbation of allergic respiratory diseases, including allergic rhinitis and allergic asthma. However, DEP-induced mechanistic pathways promoting upper airway disease and their clinical implications remain unclear. We sought to investigate the mechanisms by which DEP exposure contributes to nasal polyposis using human-derived epithelial cells and a murine nasal polyp (NP) model. Gene set enrichment and weighted gene coexpression network analyses were performed. Cytotoxicity, epithelial-to-mesenchymal transition (EMT) markers, and nasal polyposis were assessed. Effects of DEP exposure on EMT were determined using epithelial cells from normal people or patients with chronic rhinosinusitis with or without NPs. BALB/c mice were exposed to DEP through either a nose-only exposure system or nasal instillation, with or without house dust mite, followed by zinc finger E-box-binding homeobox (ZEB)2 small hairpin RNA delivery. Bioinformatics analyses revealed that DEP exposure triggered EMT features in airway epithelial cells. Similarly, DEP-exposed human nasal epithelial cells exhibited EMT characteristics, which were dependent on ZEB2 expression. Human nasal epithelial cells derived from patients with chronic rhinosinusitis presented more prominent EMT features after DEP treatment, when compared with those from control subjects and patients with NPs. Coexposure to DEP and house dust mite synergistically increased the number of NPs, epithelial disruptions, and ZEB2 expression. Most importantly, ZEB2 inhibition prevented DEP-induced EMT, thereby alleviating NP formation in mice. Our data show that DEP facilitated NP formation, possibly via the promotion of ZEB2-induced EMT. ZEB2 may be a therapeutic target for DEP-induced epithelial damage and related airway diseases, including NPs.

Cough from an allergological as well as from the ENT aspect

Cough from an allergological as well as from the ENT aspect Abstract. Cough is a common problem in the allergological, but less so in the rhinological consultation. The differential diagnostic spectrum for cough is extensive and may range from rhinitis and asthma to eosinophilic esophagitis and rarer diseases. In the case of chronic cough (> 2 months), the four most frequent causes must be sought, or be excluded (upper airway cough syndrome, asthma [cough-variant-asthma], non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease). Aeroallergens such as pollen, house-dust mites or occupational substances play a major role in allergies. Nevertheless, it is not uncommon for cough to be a main symptom of an antibody deficiency or a Sicca symptom complex. The more chronic the cough, the more thoroughly an investigation is indicated - often interdisciplinary. Therapy depends on the cause of the cough. In allergic respiratory diseases, allergy-specific immunotherapy may be indicated.

Ovalbumin-Induced Airway Inflammation Is Ameliorated in Dectin-1-Deficient Mice, in Which Pulmonary Regulatory T Cells Are Expanded through Modification of Intestinal Commensal Bacteria.

Asthma is an allergic chronic respiratory disease that affects more than 300 million people around the world. Dysbiosis of intestinal commensal microbiota influences the development of asthma. Dectin-1 (gene symbol: Clec7a), a C-type lectin receptor, plays an important role in the intestinal immune homeostasis by controlling regulatory T (Treg) cell differentiation through regulation of intestinal microbiota. However, it is not clear whether intestinal immune conditions affect immune responses in other organs. In this study, we examined the effects of Dectin-1 deficiency on allergic airway inflammation (AAI). OVA-induced AAI was attenuated in Clec7a -/- mice. Treg cells were more abundant in colonic lamina propria, mesenteric lymph nodes, and bronchoalveolar lavage fluid of Clec7a -/- mice after AAI induction. Treatment with antibiotics, but not an antifungal agent, decreased the abundance of intestinal Treg cells and aggravated the symptoms of AAI in Clec7a -/- mice. Transplantation of gut microbiota from Clec7a -/- mice into antibiotic-treated hosts increased the abundance of intestinal Treg cells and ameliorated AAI. Overcolonization by Lactobacillus murinus, a Dectin-1 signaling-regulated commensal bacterium, also promoted expansion of Treg cells in the colon and suppressed lung inflammation. Depletion of Treg cells with anti-CD25 Ab eliminated the phenotypic differences between wild-type and Clec7a -/- mice in OVA-induced AAI. These observations suggest that inhibition of Dectin-1 signaling ameliorates AAI by increasing the abundance of Treg cells in lungs through modification of intestinal commensal bacteria, suggesting a role for commensal microbiota in regulating inflammation in organs other than the intestine.

Circ_0067835 regulates allergic inflammatory response in type-2 innate lymphoid cells in allergic rhinitis (AR) via miR-155/GATA3.

Allergic rhinitis (AR) is a familiar respiratory allergic inflammatory disease with higher incidence. The pathogenesis of AR is particularly complex. Therefore, a lot of work is acquired to excavate deep mechanisms, thereby providing effective strategies for AR diagnose and treatment. AR mice model was induced by recombinant murine IL-33 (0.05µg/µl) on days 1, 3, and 5. The lentiviral vectors carrying si-circ_0067835, miR-155 mimic, si-NC or miR-NC were injected into AR mice. Thus, mice were divided into control, AR, AR + si-NC, AR + si-circ_0067835, AR + si-circ_0067835 + miR-NC, and AR + si-circ_0067835 + miR-155 mimic groups. qRT-PCR experiment was used to measure the expression of circ_0067835 and miR-155. Behavioral test result was quantified to assess AR mice model. Hematoxylin and eosin (HE) staining was performed to analyze histopathological changes. Helper T cell 2 (Th2) cytokines (IL-4, IL-5, IL-9 and IL-13) and percentage of type-2 innate lymphoid cells (ILC2s) in nasal mucosa tissues in AR mice model were evaluated needing western blot, ELISA, and flow cytometry. Besides, the targeting relationship between circ_0067835 and miR-155, or between miR-155 and GATA3, was investigated via luciferase report assay. Circ_0067835 expression levels were raised in the nasal mucosa tissues of AR mice. Inhibiting circ_0067835 could reduce Type2 cytokines and ILC2s levels in AR mice model. Furthermore, circ_0067835 targeted and positively regulated miR-155 expression, and GATA3 was a downstream target of miR-155 and adjusted by circ_0067835/miR-155 axis. In addition, silencing circ_0067835 inhibited cytokines and ILC2s levels by down-regulating miR-155. Circ_0067835 effectively inhibited AR response in ILC2s through participation of miR-155/GATA3 axis.

Safety of house dust mite subcutaneous immunotherapy in preschool children with respiratory allergic diseases

BackgroundAllergen immunotherapy (AIT) is the only causal therapy for IgE-mediated allergy. There is less evidence about the safety and efficacy of AIT especially subcutaneous immunotherapy (SCIT) in children under 5 years old. We aimed to investigate the side effects and associated risk factors of house dust mite (HDM) SCIT in preschool children with respiratory allergic diseases.MethodsThe preschool children who had HDM-related allergic rhinitis with/without asthma were enrolled and undergone standardized HDM SCIT in our department from June 2013 to December 2019. Local reactions (LRs) and systemic reactions (SRs) were recorded and categorized according to World Allergy Organization recommendations. Demographic data and other therapeutic-related parameters were also recorded to investigate potential risk factors for these side effects.ResultsA total of 91 children (60 boys, 65.93%; 31 girls, 34.07%; mean age 4.13 years old) were included in the study. Among the 91 patients, 3109 SCIT injections were recorded, 62/91 (68.13%) experienced 186 immediate LRs, 4 /91(4.40%) experienced 6 delayed LRs, 11/91 (12.09%) children experienced 44 immediate SRs, 21/44 (47.73%) were grade 1 SRs, 21/44 (47.73%) were grade 2, 2/44 (4.55%) were grade 3, no grade 4 or 5 SRs occurred. Furthermore, 1/91 (1.10%) experienced 1 delayed SRs, manifested by urticaria 2 days later after allergen injection. 9/91 (9.89%) experienced 2 or more times SRs. Multivariable logistic regression analysis showed BMI (OR 1.506; 95%CI 1.091 to 2.079; p < 0.05) and sIgE against HDM (OR 1.497; 95%CI 1.082 to 2.071; p < 0.05) were risk factors for LRs. No variable was found to correlate with SRs (all p > 0.05).ConclusionsHDM subcutaneous immunotherapy is considered to be safe in preschool children with respiratory allergic diseases. Higher BMI and HDM sIgE level in children are risk factors for developing LRs. The incidence of SRs and the rate of severe SRs are low in preschool children.

Verification and Optimization of an Ultra-Low Volume (ULV) Sprayer Used for the Inactivation of Indoor Total Bacteria

Physical and chemical cleaning for the removal of indoor microorganisms, which can cause allergic reactions and respiratory diseases, is labor-intensive and time-consuming. An ultra-low volume (ULV) sprayer, a newly introduced device to inactivate pathogenic microorganisms, allows the disinfectant particles to reach hard-to-reach spaces indoors and is more cost-effective than the existing methods. However, few studies have been conducted to verify the efficiency of the ULV sprayer. Here, we verified the disinfection efficiency of the ULV sprayer for inactivating total bacteria present on indoor surfaces, considering the factors affecting bacteria inactivation, and presented the optimal ULV sprayer usage conditions to achieve the highest disinfection efficiency depending on room size. The total bacteria removal efficiency was high (range: 0.56–2.46 log10 reductions), including hard-to-reach spaces. A response surface model was developed to identify the individual and interactive effects of the disinfectant concentration, spray amount, and room size on total bacteria disinfection efficiency. These three variables had interactive effects on the total bacteria disinfection efficiency. The experimental data were fitted to a second-order polynomial model, with high coefficients of determination (R2) for all models (R2 &gt; 0.82). The optimum conditions were a spray amount of 3.08–6.40 L in 160 m3, 3.78–7.22 L in 230 m3, and 5.68–8 L in 300 m3 surface area when using dilution rates of 100 times. These conditions predicted a bacterial disinfection efficiency of &gt;1.10 log10 reductions (92%) on all surfaces. Our results clearly indicate that the ULV sprayer effectively inactivates total bacteria present on indoor surfaces.

Association of Oral Corticosteroid Bursts With Severe Adverse Events in Children

The adverse effects from the long-term use of oral corticosteroids are known, but, to our knowledge, few studies have reported the risk of corticosteroid bursts, particularly among children. To quantify the associations of corticosteroid bursts with severe adverse events, including gastrointestinal (GI) bleeding, sepsis, pneumonia, and glaucoma, in children. This study used data derived from the National Health Insurance Research Database in Taiwan from January 1, 2013, to December 31, 2017, on children younger than 18 years of age and used a self-controlled case series design. Data were analyzed from January 1 to July 30, 2020. Oral corticosteroid bursts (defined as oral corticosteroid use for ≤14 days). Incidence rates were calculated of 4 severe adverse events (GI bleeding, sepsis, pneumonia, and glaucoma) in children who did or did not receive corticosteroid bursts. Conditional fixed-effect Poisson regression was used to estimate incidence rate ratios (IRRs) of severe adverse events within 5 to 30 days and 31 to 90 days after initiation of corticosteroid bursts. Among 4 542 623 children, 23% (1 064 587; 544 268 boys [51.1%]; mean [SD] age, 9.7 [5.8] years) were prescribed a single corticosteroid burst. The most common indications were acute respiratory tract infections and allergic diseases. The incidence rate differences per 1000 person-years between children administered a single corticosteroid burst and those not prescribed corticosteroids were 0.60 (95% CI, 0.55-0.64) for GI bleeding, 0.03 (95% CI, 0.02-0.05) for sepsis, 9.35 (95% CI, 9.19-9.51) for pneumonia, and 0.01 (95% CI, 0.01-0.03) for glaucoma. The IRRs within 5 to 30 days after initiating corticosteroid bursts were 1.41 (95% CI, 1.27-1.57) for GI bleeding, 2.02 (95% CI, 1.55-2.64) for sepsis, 2.19 (95% CI, 2.13-2.25) for pneumonia, and 0.98 (95% CI, 0.85-1.13) for glaucoma; the IRRs within the subsequent 31 to 90 days were 1.10 (95% CI, 1.02-1.19) for GI bleeding, 1.08 (95% CI, 0.88-1.32) for sepsis, 1.09 (95% CI, 1.07-1.11) for pneumonia, and 0.95 (95% CI, 0.85-1.06) for glaucoma. This study suggests that corticosteroid bursts, which are commonly prescribed for children with respiratory and allergic conditions, are associated with a 1.4- to 2.2-fold increased risk of GI bleeding, sepsis, and pneumonia within the first month after initiation of corticosteroid therapy that is attenuated during the subsequent 31 to 90 days.

Effects of nasopharyngeal microbiota in respiratory infections and allergies

The human microbiome, which consists of a collective cluster of commensal, symbiotic, and pathogenic microorganisms living in the human body, plays a key role in host health and immunity. The human nasal cavity harbors commensal bacteria that suppress the colonization of opportunistic pathogens. However, dysbiosis of the nasal microbial community is associated with many diseases, such as acute respiratory infections including otitis media, sinusitis and bronchitis and allergic respiratory diseases including asthma. The nasopharyngeal acquisition of pneumococcus, which exists as a pathobiont in the nasal cavity, is the initial step in virtually all pneumococcal diseases. Although the factors influencing nasal colonization and elimination are not fully understood, the adhesion of opportunistic pathogens to nasopharyngeal mucosa receptors and the eliciting of immune responses in the host are implicated in addition to bacterial microbiota properties and colonization resistance dynamics. Probiotics or synbiotic interventions may show promising and effective roles in the adjunctive treatment of dysbiosis; however, more studies are needed to characterize how these interventions can be applied in clinical practice in the future.

CCD Inhibition Test Can Improve the Accuracy of the Detection of Pollen and Seed Food Allergen-Specific IgE in Southern China.

ObjectiveThe presence of cross-reactive carbohydrate determinants (CCDs) may cause false-positive results in vitro allergen sIgE tests. In this paper, we focused on pollen sensitisation and its relationship with CCD in patients with respiratory allergic diseases in South China. A CCD inhibition test was conducted to assess whether patients were truly allergic to pollen or whether their sIgE was caused by a CCD cross-reaction, thus providing an important basis for clinical diagnosis and treatment.MethodsPatients with known serologic pollen sensitization were selected, and sIgE of mugwort, tree mix 20 (willow/poplar/elm tree), common ragweed, Humulus scandens, peanut, soybean and CCD was detected via the EUROBlotMaster system. Thirteen CCD-sIgE negative patients and 33 CCD-positive patients were selected, and their serum samples were subjected to the CCD inhibition test.ResultsWe found that 66.0% to 95.9% of patients sensitised to pollen and seed food allergens were co-sensitized to CCD. Additionally, 73.0% to 100% of the sIgE tests for pollen and seed food allergens turned negative after inhibition, mostly for allergens from Humulus scandens (100%, 15/15), followed by mugwort and peanut (85.2%, 23/27), ragweed (81.5%, 22/27), soybean (80.0%, 20/25), and tree pollen (73.0%, 19/26).ConclusionCCD causes false positives in the in vitro allergen sIgE tests of patients with respiratory allergic diseases in South China. Attention should be paid to the use of CCD inhibitors in diagnosing in vitro allergies because of their importance in diagnosing and treating local allergic diseases.

Editorial introductions.

Editorial introductions.

40P Revealing the association between lung cancer and allergic respiratory diseases: Meta-analysis of cohort studies

40P Revealing the association between lung cancer and allergic respiratory diseases: Meta-analysis of cohort studies

The role of human β-defensin 2 (HbD-2) and cathelicidin (LL-37) in the local protection of the upper respiratory tract in children with allergic rhinitis and bronchial asthma

Allergic diseases of the respiratory system seriously affect the psychological, physical and social aspects of the live of sick children, morally and financially exhausting members of their families as well. It is known that exacerbations of allergic diseases of the respiratory tract occur due to interaction with numerous triggers, one of which is a respiratory viral infection. At the same time, it is widely known that patients with allergic respiratory diseases are more prone to to acute respiratory infections. One of the reasons for this tendency often is an insufficient activity of non-specific factors of local immunity of the respiratory system – endogenous amphiphilic antimicrobial peptides, in particular the most studied their representatives - the family of defensins and human cathelicidin. Current research proves that these antimicrobial peptides are characterized by broad antiviral, antimicrobial and immunomodulatory activity. The aim of this study was to study the concentrations of local immune factors - human HbD-2 and LL-37 - in the secretion of the mucous membranes of the upper respiratory tract in children with asthma and allergic rhinitis and to clarify their role in protection against respiratory viral infections in this contingent of patients. We performed laboratory and clinical examinations of 76 children aged 7 to 18 years, of whom 24 were diagnosed with allergic rhinitis, 28 children - bronchial asthma, and 24 - bronchial asthma and allergic rhinitis. The control group consisted of 20 healthy children of the appropriate sex and age. In addition to general clinical methods, patterns of respiratory morbidity were analyzed and concentrations of antimicrobial peptides were determined: by ELISA human cathelicidin (LL-37), β-defensin 2 (HbD-2) in the secretion of the upper respiratory tract, statistical analysis was performed. It was found that children with allergic diseases of the respiratory tract are characterized by a higher frequency of acute respiratory infections with more frequent involvement of the lower respiratory tract, which led to an increase in the duration of the disease compared to their healthy peers. In children with allergic rhinitis and bronchial asthma, there was revealed a significant decrease in the concentrations of antimicrobial peptides in the secretion of the upper respiratory tract compared with the control group.

STAT6-dependent exacerbation of house dust mite-induced allergic airway disease in mice by multi-walled carbon nanotubes

There is increasing evidence that inhaled multi-walled carbon nanotubes (MWCNTs) can have harmful effects on the respiratory system. Rodent studies suggest that individuals with asthma may be susceptible to the adverse pulmonary effects of MWCNTs. Asthma is an allergic lung disease characterized by a TH2 immune response that results in chronic airway disease characterized by eosinophilic lung inflammation, airway mucous cell metaplasia, and airway fibrosis. Signal transducer and activator of transcription 6 (STAT6) is a transcription factor with multiple roles in TH2 type inflammation. Herein we sought to examine the role of STAT6 in the exacerbation of house dust mite (HDM) allergen-induced allergic airway disease by MWCNTs. Male wild type (WT) and STAT6 knockout (Stat6 KO) mice were dosed via intranasal aspiration on days 0, 2, 4, 14, 16 and 18 with either vehicle, HDM extract, MWCNTs, or a combination of HDM and MWCNTs. Necropsy was performed on day 21 to collect bronchoalveolar lavage fluid (BALF), serum and lung tissue. MWCNTs exacerbated HDM-induced allergic endpoints, including eosinophilic lung inflammation, mucous cell metaplasia, and serum IgE levels. HDM-induced eosinophilic lung inflammation, mucous cell metaplasia, and serum IgE and exacerbation of these endpoints by MWCNTs were ablated in Stat6 KO mice. In addition, airway fibrosis was significantly increased by the combination of HDM and MWCNTs in WT mice but not in Stat6 KO mice. These findings provide new mechanistic insight by demonstrating a requirement for STAT6 in MWCNT-induced exacerbation of allergic respiratory disease.

Role of circulating microRNA-132 in allergic bronchopulmonary aspergillosis: A case-control study

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic respiratory disease. In the current study, we aimed to evaluate the roles of miRNA-21 and miRNA132 as biomarkers in the diagnosis of ABPA.A total of 30 controls, 30 allergic asthmatic patients, 30 severe asthma with fungal sensitization (SAFS) patients, and 30 ABPA patients were included. Real-time polymerase chain reaction was used to quantify the level of miRNAs expression.The expression level of miRNA-21 was significantly higher in allergic asthmatic, SAFS, and ABPA patients in comparison with controls (p < 0.001). However, no significant difference was detected in the expression level of miRNA-21 among the different patient groups (p > 0.05). The ABPA patients had significantly higher levels of miRNA-132 expression compared to controls, allergic asthmatic patients, and SAFS patients (p < 0.001), but there was a non-significant difference between controls and allergic asthmatic patients (p = 0.09). At a cut-off of 1.52, the sensitivity of miRNA-132 expression was 93.3% and the specificity was 100% different ABPA from healthy controls. At a cut-off of 6.5, miRNA-132 expression was found to reliably differentiate between ABPA and SAFS, with a sensitivity of 86.7% and a specificity of 80%. In ABPA patients, miRNA-132 expression positively correlation with the levels of serum IL-5 (r = 0.91, p < 0.001).miRNA-132 has a role in ABPA detection and distinguishing ABPA from allergic asthma and SAFS. These preliminary data from case-control study need further studies to confirm its finding.

Populational composition of CD4&lt;sup&gt;+&lt;/sup&gt;5RA/ CD4&lt;sup&gt;+&lt;/sup&gt;5RO positive t lymphocytes and cytokine profile in children with allergic respiratory diseases

The changing states of T cell populations responsible for the chronic course of allergic inflammation and diseases, including allergic bronchial asthma, are not yet sufficiently characterized. The aim of this study was to detect phenotypic changes in the CD45RA/CD45RO positive T lymphocytes and the level of regulatory cytokines (TNFα, IFNγ, IL-4, IL-6, IL-8, IL-10, IL-13, IL-17А, IL-17F) in allergic respiratory diseases (ARD) in children. In blood of 90 children aged 3-11 (60 children with ARD and 30 healthy peers) were studied of the immune cellular populations and cytokine indices. The levels of IL-4, IL-8, IL-10, IL-13, IL-17A and IL-17F in blood serum of children with bronchial asthma and allergic rhinitis differed from appropriate indices in control group (p = 0.001). The quantity of CD3+CD8+CD45RACD45RO+cells, T helpers (p &lt; 0.05) and Th effectors simultaneously expressing both isoforms of the CD45RA+and CD45RO receptor in peripheral blood of children with ARD significantly exceeded those in control group (p &lt; 0.001). In healthy children, Th17 population (CD3+CD4+CD196 lymphocytes) comprised 9.49±1.6% of CD3+CD4+of cells, the number of such lymphocytes was significantly increased to 14.5±0.77 in children with allergic diseases (p &lt; 0.001). Absolute numbers of Th17+ cells were 93.0±9.30 and 127,0±72.0 cells/µl respectively (p = 0.002). Indicators of CD4CD45RO positive memory cells in children with ARD was determined as significantly lower (p &lt; 0.001), whereas quantity of CD3+CD19+proved to be higher (p &lt; 0.05) than in healthy peers. Absolute counts of these cells did not differ between the groups. The number of CD8+CD45RO+T lymphocytes was significantly higher in children with allergic diseases (p &lt; 0.025). This research shows that the quantitative ratio of CD3+CD8+CD45RA+and CD3+CD8+CD45RO+populations of T cells, and increased levels of cytokines, synthesizable via Th2 and Th17, in peripheral blood may be helpful for understanding genesis of allergic respiratory diseases, and extends our knowledge on immune mechanisms of allergic disorders for individualization of therapeutic programs.

Association between Exposure to Components of Pulp and Paper Industry Emissions and Diseases in Children

Introduction: To improve the efficiency of prevention and elimination of adverse health effects of airborne chemicals in children and adults, the industrially developed regions of Russian Federation face an urgent task of establishing the relationship between exposure to industrial emissions and diseases observed in the local population. The objective of our study was to establish a cause-and-effect relationship between inhalation exposure to components of pulp and paper industry emissions and health disorders in children. Materials and methods: We carried out ambient air quality testing in the residential area, established target organs and systems, assessed non-carcinogenic risk, conducted an in-depth child health examination, and modeled cause-effect relationships. Results: We established that phenol, benzene, toluene, xylene, and ethylbenzene were constantly present in the air in the vicinity of the pulp and paper mill. Their concentrations were up to 4.83 and 9.55 times higher than the average daily and one-time maximum permissible concentrations, respectively. High concentrations of chemicals posed unacceptable chronic non-carcinogenic risk of developing diseases of the respiratory, cardiovascular, immune, and nervous systems, liver, and kidney, as well as acute non-carcinogenic risk of diseases of the immune system. Elevated (up to 1.5 times) blood levels of phenol and xylenes were associated with a 2.3 times higher incidence rate of allergic respiratory diseases and an almost 1.5 times higher incidence of digestive diseases. We established the relationship between blood phenol and xylene levels and a higher incidence of allergic respiratory diseases and diseases of the biliary tract, an increased eosinophil count, nasal mucus eosinophilia, higher direct and total bilirubin in serum. Conclusion: Laboratory test results proved the relationship between inhalation exposure to phenol and xylene as components of pulp and paper industry emissions and higher incidence of diseases of the respiratory and digestive systems observed in the local child population.

Analysis of Factors Causing False-Negative Real-Time Polymerase Chain Reaction Results in Oropharyngeal and Nasopharyngeal Swabs of Patients With COVID-19.

To analyze factors regarding patient characteristics, sampling techniques, and coronavirus disease 2019 (COVID-19) specific manifestations that may cause false-negative reverse-transcription polymerase chain reaction (RT-PCR). A cross-sectional study was conducted. For the diagnosis of COVID-19, patients with RT-PCR test positive in the first nasopharyngeal and oropharyngeal swabs were accepted as true positive, and patients with negative 3 consecutive swab results were considered true negative. Those who had a negative initial swab were considered false negatives if they subsequently tested positive on the second or third swab. Demographic data of the patients, the onset of the disease, presence of nasal septal deviation, presence of epistaxis, the clinician (otolaryngologist/other physicians [OP]) who collected the samples, and medical treatments for laryngopharyngeal reflux, allergic respiratory diseases, allergic rhinitis, which include proton pump inhibitors and nasal steroids (NS), were documented. The analysis of dependent variables was performed with the chi-square test. Binary logistic regression was performed for significant variables. A total of 399 patients were included in the study, and 357 (89.5%) patients were detected as positive after 2 or 3 consecutive RT-PCR tests. The presence of ageusia, anosmia, and collecting the samples within 7 days following the onset of symptoms were determined as significant factors for positive RT-PCR results (P = <.001; odds ratio [OR] = 6.2, 5.8, 11.6, respectively). The profession of the clinician (OP), NS use, and the presence of epistaxis were detected as significant factors for the false-negative RT-PCR results (P < .001; OR = 2.3, 3.1, 8.7, respectively). Patient- and/or sample-related factors can affect RT-PCR results of possible COVID-19 cases. The presence of these factors can easily be determined in cases with high clinical suspicion and negative RT-PCR results. The presence of ageusia, anosmia, early sampling (<7days), and appropriate collection of swabs decrease false-negative RT-PCR results.

Climate change, aeroallergens, and the aeroexposome

Allergic diseases are a major public health problem globally and are increasing. The impacts of climate change on aeroallergens such as pollen and fungal spores and allergic respiratory diseases such as allergic asthma and allergic rhinitis have been considered since the early years of climate change and human health research, and exploration of this topic has accelerated over the past decade or so. This review examines the impacts of climate change on aeroallergens, including interactions with air pollutants, and the resulting impacts on allergic respiratory diseases. It discusses mitigation and adaptation in this context. It does this with a focus on advances over the last 2 years (2019 and 2020) to highlight research at the frontier of this field. It also explores the growing recognition of the need for a more holistic and integrated approach to environmental monitoring and exposure and presents the concept of the aeroexposome as a frame through which these impacts of climate change and responses to them could be viewed moving forward. As the evidence of impacts of climate change on aeroallergen production and atmospheric concentration, seasonality, distribution, and allergenicity mounts, crucial research demonstrating the resulting impacts on health outcomes such as aeroallergen sensitisation prevalence, asthma emergency department visits, and asthma hospitalisations is now emerging. It is vital that the momentum of the last decade continue with research to fill the many gaps that remain in our knowledge of this complex topic—refining analytical techniques, broadening the geographical coverage (to include, for example, the Southern Hemisphere), and more explicitly exploring the impacts of climate change on indoor aeroallergens.

Functional Examination of the Upper and Lower Airways in Asthma and Respiratory Allergic Diseases: Considerations in the Post-SARS-CoV-2 Era.

Airway examination procedures can potentially transmit infectious diseases to patients and to the health care professionals who perform them via various mechanisms. The COVID-19 pandemic has halted most of the activity of the clinics and laboratories involved in assessment of lung and nasal function, and clear recommendations in this regard have been made. Today, we still do not know for sure what its consequences will be in the short or long term, since important gaps remain in our knowledge of aspects as fundamental as virus transmission mechanisms, pathophysiology, immune response, and diagnosis. In this review, we study the examination techniques used to assess patients with respiratory allergy, asthma, and associated diseases during this period and highlight their possible advantages and disadvantages. Therefore, we focus on exploring the entire upper and lower airways, from the perspective of the safety of both health professionals and patients and their specific characteristics. We also analyze the intrinsic value of these interventions in terms of diagnosis and patient management. The changing situation of COVID-19 may mean that some of the assertions presented in this review will have to be modified in the future. While we seek to ensure a consistently broad approach, some differences in operational details may apply owing to local regulations.

Electronic Cigarettes and Their Impact on Allergic Respiratory Diseases: A Work Group Report of the AAAAI Environmental Exposures and Respiratory Health Committee

The explosive rise in popularity of electronic cigarette (e-cig) devices over the past decade has led to controversies over the role of these devices in smoking cessation and harm reduction from combustible cigarette smoking. Increased recognition of potential direct harms of e-cigs, including life-threatening and fatal cases of e-cig and vaping product use-associated lung injury, has emphasized the need to curb use until safety can be established. Of particular concern is the steep rise in e-cig use among teenagers and young adults who have never smoked and among individuals with underlying lung disease, such as asthma. In this report, we describe the different types of e-cig devices available, summarize the available data on the potential health benefits and detriments of e-cig use, and highlight the findings of studies examining e-cigs as smoking cessation tools. Because e-cigs have only gained popularity in the last few years, very few studies have been able to demonstrate an impact of e-cig use on harm reduction related to combustible cigarettes. Moreover, the health effects of e-cigs at a population level must be balanced against the harms of e-cig use, which include nicotine dependence and promoting initiation of cigarette use amongst "never smokers." With respect to smoking cessation, e-cigs appear to serve as switching products that may help individuals reduce or quit cigarette use, but do not address nicotine addiction. Finally, we discuss our recommendations for ways that health care providers can screen and counsel patients on e-cig use. The goal of this report is to provide health care providers with the most recent information on this topic so that they can educate patients on the potential pros and cons of e-cig use.