Atopic Research Articles

Early Atopic Sensitization to House-Dust Mite in Children with Recurrent Wheeze-A Cross-Sectional Study.

To determine sensitization to house-dust mite (HDM) antigen in under-five children with recurrent wheeze, compare it with nonwheezers, and assess atopic comorbidities in them. A cross-sectional study was done in the Pediatric department of a teaching hospital in North India, in 190 children aged 1-5 y. Out of these, 127 had recurrent wheeze (RW), and 63 had no wheeze (NW). Sensitivity was done by skin prick test (SPT) for two dust mites antigens: Dermatophagoide farinae and Dermatophagoide pteronyssinus antigens. In addition, atopic comorbidities like atopic dermatitis and allergic rhinitis were assessed. Mean age of the study population was 34.52 ± 20.50 mo. SPT positivity for either of the dust mites was 97 (76.4%) in RW and 13 (20.6%) in NW which was significant (p < 0.001, aOR = 12.27). HDM species sensitization for D. pteronyssinus was 55.1% vs. 15.9% (p < 0.001 aOR = 7.81) and D. farinae was 39.4% vs. 9.5% (p < 0.001, aOR = 5.45) in groups, respectively. Mean wheal size in RW Group was also significantly higher than NW group for D. pteronyssinus (2.39 ± 1.44 vs. 0.52 ± 1.19mm, median (IQR) 3 (1-3), p < 0.001), D. farinae (1.80 ± 1.39 vs. 0.32 ± 1.00mm, median (IQR) 2 (0-3), p < 0.001). Allergic rhinitis was present in 55 (43.3%) vs. 7 (11.1%) (p < 0.001), atopic dermatitis in 28 (22%) vs. 2 (3.2%) (p = 0.001) in group 1 and 2, respectively. All children with allergic rhinitis had HDM sensitization in both groups. This study showed early sensitization to HDM in children with recurrent wheeze. Atopic comorbidities were also present in them.

Relationship between Neutrophil Gelatinase-Associated Lipocalin, Eosinophil Cationic Protein, Cytokines, and Atopic Sensitization in Patients with Allergic Diseases.

The effect of neutrophil gelatinase-associated lipocalin (NGAL) on eosinophil activation, atopic sensitization, and systemic inflammation in allergic diseases has rarely been investigated. This study aimed to investigate the relationship between NGAL, eosinophil cationic protein (ECP), cytokines, and allergen-specific immunoglobulin E (sIgE) in allergic diseases. A total of 136 patients with allergies and 58 healthy individuals were evaluated. The concentrations of NGAL, ECP, tumor necrosis factor-α (TNF-α), interleukin-5 (IL-5), sIgE, total IgE (tIgE), and high-sensitivity C-reactive protein (hsCRP) were measured. The transforming growth factor-β1 (TGF-β1) level was measured as a profibrotic marker of bronchial asthma. Allergic patients had significantly higher NGAL, ECP, and hsCRP levels than healthy individuals. However, there was no significant difference in NGAL levels between patients with positive and negative ECP tests and those with high and low sIgE scores. Asthmatic patients with elevated NGAL exhibited a significantly higher TGF-β1 level than those without elevated NGAL. However, no significant difference was observed in the ECP, IL-5, and sIgE levels between the two groups. Among the patients with a positive ECP test, subjects with elevated hsCRP had two times higher NGAL levels than those without elevated hsCRP. NGAL was positively correlated with TNF-α, TGF-β1, and hsCRP, but not with ECP, IL-5, tIgE, and sIgE. An elevated NGAL level led to a 1.3-fold increase in the prevalence of high TGF-β1 (odds ratio: 1.31; 95% CI: 1.04–2.58; P < 0.001). In conclusion, NGAL elevation may be more closely linked to allergic inflammation and a possible fibrotic change in the airways than to the severity of eosinophil activation and atopic sensitization.

The links between allergen exposure and sensitization in children and adolescents: an overview for the clinician

Introduction The links between allergen exposure and sensitization are complex and depend not only on the type of allergen but on various genetic and environmental factors. Areas covered This review discusses the link between allergen exposure and atopic sensitization for different types of allergens and the factors that mediate or affect this link. For the purposes of this review search of PubMed was undertaken to identify English language articles using the terms “sensitization” and “allergen exposure” and “children/or adolescents”. Expert opinion Regarding food sensitization, the available data for peanuts and eggs suggest that there is a window period between 4-6 months of age when the introduction of these foods may limit sensitization and clinically overt allergy to the respective foods. As far as it concerns aeroallergens, it seems that there is a complex and variable relationship between mite exposure and specific sensitization especially if the exposure occurs early in life. Early exposure to dog allergens does not seem to be associated with specific sensitization; regarding cats, the results are still inconsistent. Several factors may mediate the relationship between early exposure to allergens and the development of sensitization or clinical allergy.

Prurigo crónico nodular: Estudio retrospectivo de 74 casos

Background and objectiveChronic nodular prurigo (CNPG) is a recently defined and currently underdiagnosed disease with a variety of causes. It is associated with multiple comorbidities, and its management and treatment have improved with a better understanding of its pathogenesis. The aim of this study was to describe our experience with a series of patients with CNPG. Material and methodsSingle-center, observational, retrospective study of the sociodemographic and clinical characteristics of patients with CNPG seen at the dermatology department of a tertiary care hospital between 2009 and 2021. ResultsWe included 74 patients, mostly women (63.5%), with a mean age of 57 years. Overall, 39.2% of patients had a concomitant skin condition, mainly atopic dermatitis (62%). Other comorbidities included endocrine disorders (54.1%), cardiovascular disease (44.4%), and psychiatric disorders (36.5%). Skin biopsy helped confirm the clinical diagnosis in 70% of cases. The mean immunoglobulin E level was higher than normal (516 IU/mL), regardless of atopic predisposition. On average, patients received 3 treatments, the most common choices being methotrexate, antihistamines, and topical and oral corticosteroids. Methotrexate was among the most effective options. ConclusionsCNPG is a complex disease associated with multiple comorbidities. It requires a multidisciplinary approach, with the dermatologist at the center. Classical treatment approaches are probably insufficient.

Keratosis pilaris and filaggrin loss‐of‐function mutations in patients with atopic dermatitis – Results of a Finnish cross‐sectional study

Keratosis pilaris (KP) associates with epidermal barrier defects in atopic dermatitis (AD) but its role in disease severity and concomitant atopic diseases seems to vary between populations. We performed a cross‐sectional observational study with 502 randomly selected AD patients of a Finnish tertiary health care center. At a single clinical examination, disease severity (Rajka Langeland severity score and EASI), clinical signs and patient history were evaluated and total IgE levels and frequent filaggrin (FLG) loss‐of‐function mutations were investigated. There was no link with disease severity (p = 0.649, 95% CI 0.569–0.654), asthma (p = 0.230, 95% CI 0.206–0.281) or atopic sensitization (p = 0.351, 95% CI 0.309–0.392). Keratosis pilaris was significantly associated with palmar hyperlinearity (p < 0.000, 95% CI 0.000–0.006, OR 4.664, 95% CI 2.072–10.496) and the filaggrin loss‐of‐function mutation 2282del4 (p < 0.000, 95% CI 0.000–0.009, OR 4.917, 95%CI 1.961–12.330). The prevalence of KP in the cohort was generally low and KP seems to be infrequent in Finnish AD patients. This may be explained by the fact that the tested FLG loss‐of‐function mutations are rarer in the Finnish population compared for example, with central Europe or Asia. Mutations in other locations of the FLG gene or other genes of the epidermal barrier may play a more important role.

Rates of and factors associated with atopy and allergies in posttraumatic stress disorder as compared to controls

ObjectiveSeveral studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years, SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017. MethodsSelf-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma. ResultsRates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD. ConclusionsRates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.

Adolescent Scalp Dermatitis Associated with Dermatophagoides spp. (Acariformes; Pyroglyphidae) Mite

Dermatophagoides spp. (Acariformes; Pyroglyphidae), house dust-mite well known as the causative agent of atopic hypersensitivity and allergy could potentially cause severe dermatitis. Herein we report an uncommon case of scalp dermatitis associated with the presence of Dermatophagoides spp. A 17-year old male presented with patchy alopecia on the scalp without intense peeling or itching, surround by unchanged skin and hair. Initially, superficial fungal infection was suspected; however, parasitological examination revealed the presence of live mites. All the anatomical measurements and parameters from the specimens were compatible with Dermatophagoides spp. Dermatophagoides spp. are not yet confirmed as causative agents of parasitic infestation, but the presence of these mites could have caused an allergic reaction followed by dermatitis with mild-to-moderate clinical manifestations. However, true parasitism as well as phoresy could also be considered. The clinical manifestations caused by house-dust mite cannot be easily recognized and the lack of diagnostic tools is a hindrance that often leads to misdiagnosis and inadequate therapy.

Susceptibility to Rhinovirus-induced Early Wheezing as a Risk Factor for Subsequent Asthma Development

Abstract: Rhinovirus is one of the two most common viral agents that cause bronchiolitis in young children. During the first 12 months, it is second to the respiratory syncytial virus, but after 12 months, it begins dominating the statistics. Wheezing and dry cough are typical clinical symptoms indicative of rhinovirus-induced bronchiolitis, although overlap of symptoms with other virus infections is common. Several studies have shown that atopic predisposition and reduced interferon responses increase susceptibility to rhinovirus-induced wheezing. More recent studies have found that certain genetic variations at strong asthma loci also increase susceptibility. Rhinovirus-induced wheezing in the early years of life is known to increase the risk of subsequent asthma development and may be associated with airway remodeling. This risk is increased by aeroallergen sensitization. Currently, there are no clinically approved preventive treatments for asthma. However, studies show promising results indicating that children with rhinovirus-affected first-time wheezing respond to bronchodilators in terms of less short-term symptoms and that controlling airway inflammatory responses with anti-inflammatory medication may markedly decrease asthma development. Also, enhancing resistance to respiratory viruses has been a topic of discussion. Primary and secondary prevention strategies are being developed with the aim of decreasing the incidence of asthma. Here, we review the current knowledge on rhinovirus-induced early wheezing as a risk factor for subsequent asthma development and related asthma-prevention strategies.

Food allergy in early childhood increases the risk of oral allergy syndrome in schoolchildren: A birth cohort study.

The level of pollen in Korea has increased over recent decades. Research suggests that oral allergy syndrome (OAS) may be more frequent in childhood than previously recognized. We aimed to investigate the prevalence and characteristics of OAS in children aged 6-10years from a general-population-based birth cohort. We analyzed 930 children from the cohort for childhood origin of asthma and allergic diseases (COCOA). Allergic diseases were diagnosed annually by pediatric allergists. The skin prick tests were performed with 14 common inhalant allergens and four food allergens for the general population of children aged 3 and 7years. Of the 930 eligible children, 44 (4.7%) aged 6-10years were diagnosed with OAS. The mean age at onset was 6.74years. OAS prevalence was 7.2% among children with allergic rhinitis (AR) and 19.1% among those with pollinosis, depending on comorbidity. OAS was more prevalent in schoolchildren with atopic dermatitis, food allergy, and sensitization to food allergens and grass pollen in early childhood. In schoolchildren with AR, only a history of food allergy until the age of 3years increased the risk of OAS (aOR 2.971, 95% CI: 1.159-7.615). Food allergy and food sensitization in early childhood were associated with OAS in schoolchildren with AR. Further study is required to elucidate the mechanism by which food allergy in early childhood affects the development of OAS.

Moderate-to-severe lower respiratory tract infection in early life is associated with increased risk of polysensitization and atopic dermatitis: Findings from the CHILD Study.

Respiratory infections in infancy are associated with the development of allergic asthma and atopy. Delineating whether symptomatic infections are a marker of atopic predisposition or contribute to atopic development is important for preventive strategies. We hypothesized that early, severe lower respiratory tract infections (LRTIs) may be a risk factor for the development of atopic disease. Our aim was to determine whether clinically defined, moderate-to-severe LRTIs in infancy are associated with the development of atopic dermatitis and allergic sensitization at preschool age. LRTI timing and severity in the first 18 months of life was defined by using the Canadian Healthy Infant Longitudinal Development study questionnaires. Polysensitization and atopic dermatitis were determined by standardized skin prick testing and structured clinical assessments. Longitudinal associations between LRTI severity and clinical outcomes at ages 3 years and 5 years were determined by adjusted repeated measures generalized estimation equations. Moderate-to-severe LRTIs were associated with increased odds of polysensitization (odds ratio= 1.91 [95% CI= 1.16-3.15]; P= .014) and atopic dermatitis (odds ratio= 2.19 [95% CI 1.41-3.39]; P< .001) as compared with the odds in children with no history of LRTI in the first 18 months of life. The association between moderate-to-severe LRTI and polysensitization or atopic dermatitis remained robust after adjusting for sex; study site; breast-feeding duration; and mother, father, or both-parent atopy or asthma. These results highlight severe infant LRTI as an important risk factor for allergic and atopic disease (ie, polysensitization and atopic dermatitis), and they suggest that this risk is independent of maternal in utero environment, both-parent history of asthma, and both-parent genetic predisposition.

Do Probiotics in Pregnancy Reduce Allergies and Asthma in Infancy and Childhood? A Systematic Review.

The maternal immune system is very important in the development of the foetal immune system. Probiotics have been shown to help regulate immune responses. Therefore, it is possible that the administration of probiotics to pregnant women could influence the development of the foetal immune system, reducing the likelihood of infants and children developing an allergic condition. The aim of this research was to conduct a systematic review to determine whether administering probiotics to pregnant women can reduce the incidence of allergic disease in their children. Medline, CINAHL and Embase databases were searched for randomised controlled trials (RCTs) that compared supplementation of probiotics to pregnant women to a placebo control and recorded the presentation of allergic conditions in their children. Data extracted from the study reports included their characteristics and findings. Study quality and risk of bias were assessed. From a total of 850 articles identified in the search, 6 were eligible for inclusion in this review. Two studies found no effect of maternal probiotics on the outcomes measured, two studies found that the incidence of eczema or atopic dermatitis (AD) was reduced by maternal probiotics, one study found no effect on the overall incidence of atopic sensitisation, but a reduction in a subgroup of children at high hereditary risk of allergic disease, and one study found no effect in an intention to treat analysis, but a reduction in AD in complete case analysis. The results of these studies are inconsistent but demonstrate that probiotics may have the potential to reduce infant allergies when administered prenatally, particularly in children at high risk of allergy development. There is a need for further larger-scale studies to be performed in order to provide a more definitive answer. Such studies should focus on at-risk groups.

Gut microbial influences on the adaptive immune system and the development of cow milk allergy.

Allergic diseases constitute significant health and economic issues in both developed and developing nations, with epidemiological studies demonstrating a rapid increase in the global prevalence of food allergy among the pediatric population. Cow milk protein allergy (CMPA), one of the most common forms of food allergies observed in early childhood, affects between 2%–6% of infants and children under 3 years of age. CMPA can present as either an IgE-mediated atopic allergy or a non-IgE mediated allergic response. Antigen-specific T cells play a pivotal role in directing the type of inflammatory immune response that occurs as well as in the formation of immunological memory. IgE-mediated CMPA is thought to develop because of an abnormal expansion of allergen-specific type-2 helper T (Th2) cells and a corresponding deficiency in immune regulation by regulatory T cells (Tregs), thereby altering the Th2/Treg balance. The gut microbiota, established very early during childhood through host-microbe interactions, can influence the incidence of allergic diseases. In this study, we aimed to analyze both the microbiome composition and CD4+T cell differentiation patterns in pediatric patients with and without cow milk allergy to establish the association between these factors. Using 16S rRNA sequencing, we analyzed the microbiome composition in stool samples of allergic and non-allergic pediatric patients aged between 1–4 years and identified the microbial species abundant in IgE and non-IgE mediated cow milk allergies. To assess the CD4+T cell differentiation patterns, peripheral blood mononuclear cells (PBMCs) from these patients were re-stimulated with cow milk antigen, and T cell subsets were assessed using flow cytometry. Antigen-specific CD4+T cells were identified and sorted for high throughput sequencing and subsequent gene expression analysis. The CD4+T cell differentiation patterns of the total and antigen-specific T cells were analyzed and statistically compared with controls. The identification of the correlation between the CD4+T cell differentiation patterns and species-specific microbial abundance in IgE and non-IgE mediated cow milk allergies can help in determining how the gut microbiome influences the CD4+T cell immune compartment development, ultimately leading to the development of cow milk allergy in pediatric patients.

Evaluation of Skin Prick Test Reading Time at 10 versus 15 min in Young Infants

Introduction: The optimal time point for reading the mean wheal diameter (MWD) of a skin prick test (SPT) in infants is not established. We aimed to assess if either of two reading time points of the SPT, 10 or 15 min, was superior to detect allergic sensitization (AS) in 6-month-old infants. Methods: In 1,431 6-month-old infants from the population-based Preventing Atopic Dermatitis and ALLergies in children (PreventADALL) mother-child cohort, the SPT was performed with standard solutions for egg, cow’s milk, peanut, wheat, soy, birch, timothy, dog, and cat. The MWD was measured after 10 and 15 min. AS was defined as a positive SPT with MWD ≥2 mm larger than the negative control. Results: Overall, 149 (10.4%) infants were sensitized to at least one allergen at 10 and/or 15 min, while 138 (9.6%) had a positive SPT at 10 min and 141 (9.9%) at 15 min. A total of 12,873 allergen pricks were performed with 212 (1.6%) being positive at any time point, 194 (1.5%) positive at 10 min, and 196 (1.5%) positive at 15 min. The mean (95% CI) histamine MWD of 3.8 (3.8, 3.9) mm at 10 min was significantly larger than the 3.6 (3.6, 3.7) mm at 15 min. Discussion/Conclusions: Reading the SPT after both 10 and 15 min increased the number of 6-month-old infants with documented AS compared to reading after one time point only. As neither 10 nor 15 min reading time was superior to the other in detecting AS, our results indicate that readings at both time points should be considered. However, the histamine MWD was significantly larger at 10 min compared to 15 min. Reappraisal of SPT reading in infancy may be warranted.

Associations of Four sensitization patterns revealed by Latent Class Analysis with Clinical symptoms: A multi-center study of China

SummaryBackgroundBecause of the significant regional differences in the distribution of allergens, the relationship between anaphylaxis and allergic sensitization is complex in China. Using this large-scale epidemiologic survey, we explore the potential patterns of sensitization to common allergens in mainland China and investigate their relationship with various clinical symptoms.MethodThe participants were recruited from 13 medical centers in mainland China from October 2019 to June 2021. Skin prick test (SPT) results that cover 18 common allergens were utilized to diagnose atopic sensitization. The demographic characteristics and clinical information were collected through questionnaires during routine medical follow-up. Latent class analysis (LCA) was conducted to determine the optimal sensitization patterns. The logistic regression was used to assess the associations of different sensitization patterns with allergy symptoms.FindingsA total of 1089 patients who had a positive SPT to at least one of 18 allergens were included for formal analysis. An optimal LCA model with 4 classes was obtained in this study, and the corresponding labels were as follows: Class1, house dust mite sensitization; Class2, low pollen sensitization; Class3, middle pollen sensitization; Class4, high pollen sensitization. The prevalence of different classes varied widely in geographical distribution, which was characterized by Class1 being very common in south and east as well as Class2 in north and west of China. Compared with patients in Class1, those in middle and high pollen sensitization clusters had the higher odds ratios (ORs) of allergic rhinitis and allergic conjunctivitis when controlling for other confounders. However, there was no significant difference between low pollen sensitization and house dust mite sensitization groups in the risks for various clinical performances except dermatitis. Additionally, the adjusted ORs (95% confidence interval) of allergic conjunctivitis and dermatitis for participants in pollen sensitization clusters (Class2, 3 and 4) were 1.56 (1.18, 2.06) and 1.43 (1.09, 1.88) respectively compared with those in Class1.InterpretationIn this study, we identified four sensitization clusters with specific risks of various clinical symptoms using common allergens by adopting LCA. Our findings may contribute to improved diagnosis and potential immunotherapy approaches to allergy in mainland China.FundingThis study was supported by the National Natural Science Foundation of China (81802076 and 81871736), the Guangzhou Science and Technology Foundation (202102010327), the Foundation of SKLRD (MS-2019-06 and Z-2022-09), and the Foundation of GYYY (ZH201904) and ZNSA-2020012.

Local and Systemic Production of Pro-Inflammatory Eicosanoids Is Inversely Related to Sensitization to Aeroallergens in Patients with Aspirin-Exacerbated Respiratory Disease.

Aspirin-exacerbated respiratory disease (AERD) is characterized by overproduction of the pro-inflammatory eicosanoids. Although immunoglobulin E-mediated sensitization to aeroallergens is common among AERD patients, it does not belong to the defining disease characteristics. In this study of 133 AERD patients, we sought to find a relationship between sensitization to aeroallergens and local (leukotriene E4, prostaglandin E2 and prostaglandin D2) and/or systemic (leukotriene E4) production of arachidonic acid metabolites. Interestingly, a negative association between pro-inflammatory eicosanoid levels in induced sputum supernatant or urine and sensitization to aeroallergens was observed. This inverse relationship might suggest the presence of a protective effect of atopic sensitization to aeroallergens against stronger local airway inflammation and higher systemic AERD-related inflammatory activity.

The Effect of Atopy on the Incidence of Osteitis in Patients with Chronic Rhinosinusitis.

BackgroundAtopy may not contribute directly to the pathogenesis of chronic rhinosinusitis (CRS) and could be a coexisting disease, but it may play a disease-modifying role in CRS. The aim of this study was to determine the effect of atopy on the incidence of osteitis in patients with CRS.MethodsA cross-sectional study at a tertiary center was conducted. Computed tomography of paranasal sinuses (CTPNS) of 75 CRS patients was analyzed. Skin prick test was used to determine the atopy among the CRS patients. The evaluation consisted of symptom score, Lund–Kennedy endoscopic score and CTPNS assessment by Lund Mackay (LM) staging system and Global Osteitis Scoring Scale (GOSS).ResultsAbout 54.7% of CRS patients had atopy (n=41), and 64% (n=48) had osteitis changes. No significant difference (p>0.05) was found for symptom and endoscopic scores in atopic and non-atopic CRS. Atopic and non-atopic CRS patients demonstrated comparable LM and GOSS scores (both p>0.05). Logistic regression analysis revealed that gender, nasal polyps and bronchial asthma were significantly associated with the incidence of osteitis. Significant correlation was found between LM and GOSS scores in atopic CRS (r=0.81, p<0.05). Correspondingly, both scores were found to be significantly correlated in non-atopic CRS (r=0.74, p<0.05).ConclusionAtopic sensitization has no effect on the incidence and severity of osteitis in patients with CRS. The present study suggests that osteitis occurs independently from the atopic pathway.

Respiratory syncytial virus specific immunoglobulin G4 antibodies and atopic diseases in children.

It has been proposed that RSV infection stimulates RSV specific IgE and IgG4 production as a hallmark of Th2 immune response, which can contribute to the development of allergic sensitization and atopic diseases. This study intends to examine the occurrence of atopic diseases in children (wheezing bronchitis, food allergy, atopic dermatitis) and their connection with RSV specific IgE and IgG4 during the first two years of life. Prospective follow-up from the moment of birth was performed in 127 children with positive RSV specific IgG antibodies at age 1 and 92 children were followed-up until two years of age. The assessment included a structured interview, clinical examination, total blood eosinophils, serum total IgE and allergen specific IgE antibodies, RSV specific IgG, IgG3, IgG4 and IgE antibodies. Significant correlation was found between positive RSV IgG4 antibodies at year one and atopic dermatitis (Tau_b=0.201, P=0.025), as well as food allergy development (Tau_b=0.205, P=0.023). RSV specific IgG4 antibodies to RSV at year one showed significant prediction of increased total and/or allergen specific IgE (odds ratio 2.73 and 95% confidence interval 1.07 - 7.00, P=0.036). In our regression model, the children who had positive RSV IgG4 antibodies had a 2.73 times higher likelihood of having increased positive total and/or allergen specific IgE during the first two years of life. RSV specific IgG4 antibodies could be a marker of risk for the development of atopic sensitization to inhaled and food allergens, development of food allergy and atopic dermatitis in atopic children.

Reflux-related symptoms reflect poor asthma control and the presence of airway neuronal dysfunction

BackgroundGastroesophageal reflux may be associated with the worsening of asthma by increasing cough reflex sensitivity. Hull Airway Reflux Questionnaire (HARQ) consists of 14 prevalent reflux-related symptoms. It may be useful in predicting the presence of cough reflex hypersensitivity in asthma. MethodsFrom August 2018 to July 2020, 266 asthmatic patients completed the HARQ. They underwent blood analysis, spirometry, fraction of exhaled nitric oxide (FeNO) measurement, and the capsaicin cough challenge test. Patients were considered to have reflux-related symptoms if their HARQ scores were 13 points or higher. We evaluated the association between reflux-related symptoms and clinical asthma outcomes. Finally, we performed a multivariate analysis to determine the clinical significance of the HARQ for asthma. This study was registered in the University Hospital Medical Information Network (UMIN000040732). ResultsThe mean HARQ scores were 13.1 (standard deviation 12.0). Patients in the high HARQ scores group (HARQ ≥13, n = 105) showed a lower prevalence of atopic predisposition, lower levels of FeNO, heightened capsaicin cough reflex sensitivity, poorer asthma control, and more frequent admissions due to asthma than those in the low HARQ groups (all p values < 0.05). The HARQ was useful in selecting patients with poor controlled asthma and those with severe cough when the cut-off value was set at 13. Multivariate analysis revealed that heightened capsaicin cough reflex sensitivity affected reflux-related symptoms, as well as lower levels of FeNO and younger age. ConclusionsHigher HARQ scores (≥13) may be useful in predicting not only poor asthma condition but also the presence of airway neuronal dysfunction in patients with asthma to some extent.

Ферментопатия как причина кожных проявлений атопии у детей

Статья посвящена ферментопатиям как одной из возможных причин атопического дерматита у детей. Функциональные нарушения органов пищеварения приводят к всасыванию неполноценно расщепленных компонентов пищи, особенно белков, и тем самым способствуют сенсибилизации организма к различным видам аллергенов. При атопическом дерматите у детей встречаются следующие функциональные нарушения органов пищеварения: рефлюксы, дискинезии, заболевания слизистой оболочки, холестаз, относительная панкреатическая недостаточность, дисбиоз кишечника. Задача врача состоит в углубленном обследовании таких пациентов и назначении комплексной терапии атопического дерматита с учетом выявленных изменений со стороны желудочно-кишечного тракта.

Environmental pollution and allergy

Air pollution, climate change, and the decrease of biological diversity are major threats to human health. In the past decades, an increase in allergic diseases, including asthma and rhinoconjunctivitis, has been observed. Up to 40 % of the world population may have an allergic disease, which represents a significant impact on the quality of life of those who suffer from it, and environmental pollution is one of the causes of its presentation. Air pollution causes significant morbidity and mortality in patients with inflammatory airway diseases such as allergic rhinitis, chronic rhinosinusitis, asthma, and chronic obstructive pulmonary disease. Oxidative stress in patients with respiratory diseases can induce eosinophilic inflammation in the airways, increase atopic allergic sensitization, and rise susceptibility to infections. Climate change has influenced exposure to extramural allergens and it is associated with exacerbations of respiratory diseases in the upper and lower airway. The interaction of indoor and outdoor environmental exposure and host factors can affect the development and progression of lifelong allergic diseases. The decrease of exposure to air pollutants has been associated with a favorable response in respiratory health, which is why it is necessary to implement measures that contribute to an improvement in air quality.