Chronic Allergy Research Articles

Long‐term results after primary frontal sinus surgery

The objectives of this study were to evaluate the long-term frontal ostium patency rate and symptom improvement in patients undergoing primary endoscopic frontal sinusotomy (Draf 2A) and to assess the impact of patient factors, disease factors, and frontal ostium size on surgical outcomes. Retrospective chart review was used. Endoscopic assessment of frontal ostium patency and patient-reported symptoms were prospectively collected on patients who underwent primary frontal sinusotomy between January 2003 and December 2009. A total of 109 patients underwent primary endoscopic surgery on 210 frontal sinuses over the study period. The overall patency rate was 92%. Complete resolution of symptoms was noted in 85 patients (78%). Stenosis of the frontal sinus ostium correlated significantly with persistence of symptoms, infection, or polyp recurrence (p = 0.0066), and frontal ostium size (p < 0.03). No significant correlation could be found between the presence of eosinophilic mucin, asthma, polyposis, and smoking on patency or resolution of symptoms. To our knowledge, this is the largest study of primary endoscopic frontal sinus surgery in the literature. The technical and subjective measures of success are high. Frontal ostium size correlates with risk of stenosis of the frontal sinus. Patients with a stenosed frontal ostium and residual frontal sinus disease are more likely to be symptomatic or have endoscopic evidence of polyp recurrence or endoscopic evidence of persistent infection. Asthma, eosinophilic mucin chronic rhinosinusitis (EMCRS), allergy, and smoking do not appear to affect outcomes.

Impacto de los trastornos crónicos en la esperanza de vida de la población de Cataluña en 1994 y 2006

This paper analyzes the changes in the prevalence of selected chronic conditions and their impact on the life expectancy in the population of Catalonia. The chronic conditions selected are: hypertension, diabetes, stroke, heart diseases, chronic bronchitis, asthma, chronic allergies, musculoskeletal system diseases, and anxiety/depression. The prevalence of these diseases is estimated from data collected by the Health Survey of Catalonia in 1994 and 2006. The most frequently chronic conditions among the Catalan population are the musculoskeletal disorders, the high blood pressure and the depression and/or anxiety. By the analysis of the changes in the life expectancy free of chronic disorders, this study shows the impact of these disorders in the life expectancy. The burden of the chronic morbidity in our community, and its impact on the health systems, requires further studies to increase the knowledge of this phenomenon.

Paranasal Sinus Mucosal Hypertrophy in Experienced Divers

Due to the increasing popularity in recreational diving long-term health consequences of this sport have aroused interest in the diving community. Although not as important as dysbaric osteonecrosis, ischemic brain lesions, or neurophysiological symptoms, paranasal sinus mucosal hypertrophy (PSMH) has also been discussed as being more prevalent among divers. In this study, we used magnetic resonance imaging (MRI) to compare asymptomatic divers with control subjects for PSMH. We enrolled 79 male divers (34.0 +/- 5.7 yr) and 79 nondiving age- and sex-matched controls (33.8 +/- 6.1 yr). We used a questionnaire to elicit diving history. Divers with a history of sinus barotrauma, subjects with a history of chronic sinusitis or nasal allergies, and those with retention cysts, nasal polyps, or mastoiditis were excluded. T1-, T2-weighted axial and coronal images of the paranasal sinuses were taken with a 1.5-T MRI device. The threshold for PSMH was defined as mucosal thickness above 3 mm. MRI revealed PSMH in 33 (41.8%) divers and 18 (22.8%) controls. There were no significant differences between the groups with respect to age, smoking history, or alcohol consumption. PSMH identified in divers did not show an association with age or diving history. The higher rate of PSMH identified in divers suggests that diving may cause changes in the paranasal sinus mucosa.

Adipose tissue inflammation contributes to body weight loss induced by experimental chronic food allergy in mice

Food allergy affects approximately 5% of children and 3% of the adult population in the western world. This disease is the manifestation of an abnormal immune response to antigens introduced into the organism orally and it is often mediated by IgE. Our group developed a chronic mouse model for the food allergy and one of the most remarkable alterations observed is a loss of body weight. However, the disturbances that trigger this loss of body weight are not clear. Thus, the purpose of this study was to investigate the mechanisms involved in weight loss of mice with ovalbumin-induced food allergy. With this purpose, BALB/c mice were subcutaneously sensitized with ovalbumin in aluminum hydroxide and challenged with the antigen containing diet for 7 days. The allergic mice showed significant weight loss with loss of adipose tissue, although it was not observed a reduction in food intake. These mice demonstrated adipose tissue inflammation characterized by increased leukocyte recruitment (visualized by intravital microscopy) and infiltration of mast cells, macrophages and regulatory T cells in the stroma. Moreover, we demonstrated high concentrations of TNF-a ,I L-6, IL-10 and the chemokine MCP-1/CCL-2 in this tissue. The metabolic changes in adipose tissue of allergic animals were represented by increased glucose uptake and lipolysis in adipocytes, resulting in atrophy of these cells. Changes were also seen in systemic metabolism characterized by decreased serum concentrations of glucose, triglycerides, total cholesterol and free fatty acids in allergic mice. Based on our results, we conclude that food allergy induces adipose tissue inflammation by producing mediators that lead to atrophy of this tissue. The decrease in adipose tissue mass has systemic consequences and results in loss of body weight.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) as a New Biomarker for Non – Acute Kidney Injury (AKI) Diseases

Neutrophil gelatinase-associated lipocalin, or NGAL, an acute phase protein, is part of the lipocalin family. NGAL is highly induced in inflammatory conditions and ischemia, and is a critical component of innate immunity to bacterial infection. Recently, NGAL has been proven as an emerging biomarker for predicting acute kidney injury (AKI). Meanwhile, numerous studies have also demonstrated that NGAL may be a potential biomarker for the diagnosis, prediction, prevention, and prognosis of non--AKI diseases such as chronic kidney diseases, vascular disorders, cancer, preeclampsia, and allergies. This article systematically reviews the clinical utilities of NGAL as a new biomarker for non--AKI diseases.

Biological terrorism and the allergist's office practice

During the anthrax outbreak and threat in Trenton (2001), our allergy practice experienced increased visits from approximately 50 of our regular patients with symptoms they believed resulted from anthrax exposure. In all cases, their symptoms were caused by a combination of an exacerbation of their underlying allergic disease and anxiety because of possible exposure to anthrax. Our objective is to present an orderly approach to the allergist's outpatients presenting with possible exposure to a bioterrorist's agent. The 10 precepts of approach to the management of a biological casualty (index of suspicion, protect yourself, patient assessment, decontaminate, diagnose, treat, infection control, alert authorities, assist in investigation, and maintain proficiency) and the epidemiological characteristics of a biological attack are discussed. In table form, we compared the signs and symptoms of the most common outpatient consultations to an allergist's office practice (chronic rhinitis, asthma, food allergy, venom allergy, atopic dermatitis, drug allergy, chronic urticaria, acute urticaria, immunodeficiency, and anaphylaxis) with those of likely bioterrorism threats. Descriptions of smallpox, plague, tularemia, anthrax, viral hemorrhagic fevers, Q fever, brucellosis, Venezuelan equine encephalitis, glanders, and melioidosis are presented. Patients may readily mistake their allergic symptoms with those of infection with a bioterrorist's agent. At the same time, the allergist may be faced with one of his own chronic patients presenting with symptoms resembling their allergic disease but actually caused by one of the aforementioned pathogens.

Phosphatidylinositol 3-Kinase Isoforms as Novel Drug Targets

Phosphatidylinositol 3-kinases (PI3Ks) are key molecules in the signal transduction pathways initiated by the binding of extracellular signals to their cell surface receptors. The PI3K family of enzymes comprises eight catalytic isoforms subdivided into three classes and control a variety of cellular processes including proliferation, growth, apoptosis, migration and metabolism. Deregulation of the PI3K pathway has been extensively investigated in connection to cancer, but is also involved in other commonly occurring diseases such as chronic inflammation, autoimmunity, allergy, atherosclerosis, cardiovascular and metabolic diseases. The fact that the PI3K pathway is deregulated in a large number of human diseases, and its importance for different cellular responses, makes it an attractive drug target. Pharmacological PI3K inhibitors have played a very important role in studying cellular responses involving these enzymes. Currently, a wide range of selective PI3K inhibitors have been tested in preclinical studies and some have entered clinical trials in oncology. However, due to the complexity of PI3K signaling pathways, developing an effective anti-cancer therapy may be difficult. The biggest challenge in curing cancer patients with various signaling pathway abnormalities is to target multiple components of different signal transduction pathways with mechanism-based combinatorial treatments. In this article we will give an overview of the complex role of PI3K isoforms in human diseases and discuss their potential as drug targets. In addition, we will describe the drugs currently used in clinical trials, as well as promising emerging candidates.

Chronic spontaneous urticaria is not an allergic disease

The links between chronic urticaria, IgE sensitization and allergy have been much discussed but little studied. We investigated IgE sensitization and allergy in 128 adult chronic urticaria patients during 2006-2008. During a one-day hospitalisation, the patients answered a standardized questionnaire and underwent blood serum analysis, physical tests and skin prick-tests. IgE sensitization to environmental allergens was defined by the positivity of at least one skin prick test and/or elevated levels of serum IgE ≥ 300 Kui/L. The chronic urticaria was considered allergic if: i) a high correlation between positive skin prick tests to a clinically relevant allergen and the case history was found; ii) complete remission of urticaria occurred within two months of allergen withdrawal. Of 105 patients with interpretable skin prick tests, 46.7% were IgE sensitized. Two patients had clinically relevant positive skin prick tests but their chronic urticaria had many other triggering factors and neither was in complete remission after withdrawal of these allergens. IgE sensitization is higher in chronic urticaria patients than in the global adult population, suggesting that it is one important etiopathogenic factor in chronic urticaria. However, it cannot be considered as the expression of an IgE-mediated allergy but as a chronic inflammatory disease, more frequent in IgE sensitized people and favoured by multiple factors, among which IgE-mediated allergy is exceptional.

Harmonising spirometry education with HERMES: training a new generation of qualified spirometry practitioners across Europe: Figure 1–

“Hundreds of millions of people of all ages suffer from preventable chronic respiratory diseases and respiratory allergies in all countries of the world… accounting for 4 million deaths annually” 1. The considerable toll of respiratory diseases in terms of quality of life, disability of patients and indeed premature death 2 underlines the importance of spirometry in the detection and monitoring during the management of respiratory disease. Yet, in the past two decades, there have been specific concerns of under-utilisation in screening 3, lack of training 4 and misdiagnosis based on inaccurate results 5, 6 which only serve to document the inadequacies in spirometry practice not only within Europe but on a world-wide scale. An abundance of reports 2–8 has propelled quality issues in the practice of spirometry to centre stage and consequently introduced a number of quality improvement strategies. High-quality spirometry relies on three key determinants: 1) documented guidelines in spirometry, 2) access to quality spirometers, and finally, 3) trained and qualified spirometry practitioners 9. To some degree, the ERS/ATS guidelines in standardisation of spirometry 10 and availability of affordable spirometers across medical settings have directly addressed these first two factors. Further efforts implemented in the US by NIOSH (National Institute for Occupational Safety and Health), in several European countries, as well as across New Zealand and Australia through ANZSRS (Australian and New Zealand Society of Respiratory Science) have produced comprehensive training structures with supporting documents and certification criteria to endorse health professionals with a qualification to practice high-quality spirometry. There is some evidence which consistently shows that competence in spirometry is the key to quality services 7, 11, 12, but access to such training and assessment is relatively limited. Adopting HERMES (Harmonising Education in Respiratory Medicine for European Specialists) as …

Comparison of Pre- and Post-treatment Pain Scores of Twenty One Horses with Laminitis Treated with Acupoint and Topical Low Level Impulse Laser Therapy

Low-level impulse lasers have been applied focally to stimulate acupoints (laser acupuncture) and topically over wounds, joints and other tissues to increase circulation and promote healing. Laser acupuncture has been used to treat neck and back pain, tendonitis, osteoarthritis, injuries, chronic allergies, immune-mediated disorders, internal medical disorders and other diseases. Low level impulse laser therapy (LLLT) reduces inflammation and muscle spasms, increases blood perfusion and encourages clearance of peroxide radicals and healing in abscessed and degenerating tissues. Twenty one horses with laminitis were presented to the author for LLLT on acupoints and topically to encourage microcirculation and demarcation of abscesses of the hoof. Before and after completion of a series of LLLT treatments, each horse was evaluated and given a pain score based on a pre-determine pain scale. The mean ± standard deviation of pre- and posttreatment pain scores were compared with a t-test and were significantly different at p&lt;0.001. Photographs of severe cases of laminitis in horses recommended for euthanasia are shown before and after LLLT. The results of this pilot study support the use of LLLT as a primary or adjunctive treatment option for equine laminitis and indicate the need for further exploration of LLLT for laminitis and other diseases in animals.

CCR3 as a single selection marker compared to CD123/HLADR to isolate basophils in flow cytometry: Some comments

CCR3 as a single selection marker compared to CD123/HLADR to isolate basophils in flow cytometry: Some comments

Expression of recombinant human interleukin-8 and its purification using a single buffer system

Chemokines, a class of small secreted proteins, direct immune cells to their target sites and play an important role in chronic inflammations and allergies. To study their interactions with their cellular receptors or potential inhibitors large quantities of chemokines are required. Here we present a fast and efficient strategy to purify the human chemokine interleukin-8 (IL-8, CXCL8). The chemokine is expressed with a pelB-leader peptide that is cleaved off its N-terminus by an endogenous bacterial peptidase. This yields wild-type 72aa IL-8 with a serine at its N-terminus. IL-8 is recovered in the soluble fraction after lysis while pelB-IL8 fusion protein remains in the pellet. Interleukin-8 is purified via cation exchange chromatography and heparin affinity chromatography using a single inexpensive buffer system. No dialysis or membrane filtration steps are required and the final protein fractions may be used without any desalting steps. The use of 0.5% Triton X-114 in the lysis buffer leads to low endotoxin levels in the resulting protein. The protein can be eluted from the gel filtration column with a variety of buffers and is ready to be used in binding assays and activity assays.

Follow‐up of adolescents born extremely preterm: cognitive function and health at 18 years of age

To compare cognitive ability, school achievement and self-perceived health aspects in adolescents born extremely preterm and term born controls. Fifty-two, out of 61, extremely preterm born adolescents (mean age 18.4 years) and 54 matched controls (mean age 18.3 years) born at full term were investigated; intelligence quotient was measured with the Wechsler Adult Intelligence Scale; cognitive flexibility, i.e. a measure of visuomotor speed and attention, with the Trail Making Test; school achievement and choice of upper secondary programmes were reported. Health aspects were investigated in a semi structured interview. The adolescents born prematurely had significantly lower IQ than the controls, mean 93 (SD 15.4) vs 106 (12.5), p < 0.001; showed slower visuomotor speed; had lower grades from compulsory school (192.7 vs 234.8, p < 0.001); and chose to a greater extent practical upper secondary school programmes. There were no differences between the groups in health care consumption, prevalence of chronic disease, allergy or infectious diseases. Poorer cognitive performance, in extremely preterm born individuals, seems to persist into late adolescence. Fewer prematurely born than control chose theoretical upper secondary school programmes. However, no difference was noted regarding self-perceived health aspects.

Healing advantages of lavender essential oil during episiotomy recovery: A clinical trial

Episiotomy is the most common perineal incision in obstetric and midwifery. Nowadays alternative and complementary methods such as Aromatherapy using essential oils are established as an alternative therapy. This research was carried out to assess the effect of lavender oil in wound healing. This randomized control trial was conducted on 120 primiparous women with singleton pregnancy, without any acute and chronic disease and allergy who had undergone normal spontaneous vaginal delivery and episiotomy. They were randomly allocated in case and control groups. Case group received lavender oil and controls received povidone-iodine. Incision sites were assessed on the 10th day postpartum. 25 out of 60 women in lavender group and 17 mothers in control group had no pain (p = 0.06). There was no significant difference between two groups in surgery site complications. However, redness in lavender group was significantly less than controls (p < 0.001). This study suggests application of lavender essential oil instead of povidone-iodine for episiotomy wound care.

Phthalate exposure and asthma in children

During the last decades more than 100 000 new chemicals have been introduced to the environment. Many of these new chemicals and many common consumer products that include these have been shown to be toxic in animal studies and an increasing body of evidence suggests that they are also impacting human health. Among the suspect chemicals, the endocrine disrupting chemicals (EDCs) are of particular concern. One such chemical group is the phthalates, used in soft poly vinyl chloride (PVC) material and in a huge number of consumer products. During the same period of time that the prevalence of these modern chemicals has increased, there has been a remarkable increase in several chronic illnesses, including asthma and allergy in children. In this article we outline the scientific knowledge on phthalate exposure for asthma and airway diseases in children by examining epidemiological and experimental peer review data for potential explanatory mechanisms. Epidemiological data point to a possible correlation between phthalate exposure and asthma and airway diseases in children. Experimental studies present support for an adjuvant effect on basic mechanisms in allergic sensitization by several phthalates. Despite variations in the experimental design and reported result in the individual studies, a majority of published reports have identified adjuvant effects on Th2 differentiation, production of Th2 cytokines and enhanced levels of Th2 promoted immunoglobulins (mainly IgG1 but also IgE) in mice. A limited amount of data do also suggest phthalate-induced enhancement of mast cell degranulation and eosinophilic infiltration which are important parts in the early inflammation phase. Thus, some of the early key mechanisms in the pathology of allergic asthma could possibly be targeted by phthalate exposure. But the important questions of clinical relevance of real life exposure and identification of molecular targets that can explain interactions largely remain to be answered.

Peptides Targeting Toll-Like Receptor Signalling Pathways for Novel Immune Therapeutics

Toll-like receptors (TLRs) are a family of key proteins that permit mammals to detect microbes and endogenous molecules, which are present in body fluids, cell membranes and cytoplasm. They confer mechanisms to the host for maintaining homeostasis, activating innate immunity and inducing signals that lead to the activation of adaptive immunity. TLR signalling induces the expression of pro-inflammatory and anti-viral genes through different and intricate pathways. However, persistent signalling can be dangerous and all members of the TLR family are involved in the pathogenesis of acute and chronic inflammation, autoimmunity, allergy, cancer and aging. The pharmaceutical industry has begun intensive work developing novel immunotherapeutic approaches based on both activation and inhibition of TLR triggering. Further, clinical trials are pending to evaluate TLR agonists as novel vaccine adjuvants and for the treatment of infectious diseases, allergic diseases and asthma. Since systemic, metabolic and neuroendocrine changes are elicited by inflammation, TLR activity is susceptible of regulation by hormones and neuroendocrine factors. Neuroendocrine mediators are important players in modulating different phases of TLR regulation contributing to the endogenous control of homeostasis through local, regional and systemic routes. Vasoactive intestinal peptide (VIP) is an important signal molecule of the neuroendocrine-immune network that has recently emerged as a potential candidate for the treatment of inflammatory and autoimmune disorders by controlling innate and adaptive immunity. This review shows current advances in the understanding of TLR modulation by VIP that could contribute to the use of this natural peptide as a therapeutic tool.

Streptokinaz Allerjisine Bağlı Tek Taraflı Akut Pulmoner Ödem

We report an unusual case of immune-mediated unilateral acute pulmonary edema (APE) following streptokinase administration for acute ST segment elevation myocardial infarction. To our knowledge, no report of overt unilateral APE is associated with streptokinase hypersensitivity during myocardial infarction therapy or following it. We stopped the streptokinase infusion because patient's blood pressure and oxygen saturation dropped as soon as streptokinase was administered. Then patient's antero-posterior chest X-ray showed that unilateral APE (Figure 1, Unilateral acute pulmonary edema, Antero-Posterior chest X-ray ). We did not find any other cause such as pulmonary embolism, heart failure, mitral regurgitation or re-expansion except streptokinase hypersensitivity reaction in our case for unilateral APE. Patient was treated with steroids, antihistaminics plus diuretics and then his clinical status improved. Hypersensitivity reactions to streptokinase are uncommon and usually minor; in the ISIS-2 trial only 4.4% of patients suffered from an allergic reactions to streptokinase.1 Allergic reac- tions induced by streptokinase may be manifest as urticaria, bronchospasm, angioneurotic or periorbital edema or unilateral interstitial edema in lungs.2 Patients with a history of prior exposure to streptokinase, infections with streptococci, and chronic allergic reactions are at risk for either by inducing an allergic response or by neutralising the streptokinase and making it ineffective.

The Modulation of Adaptive Immune Responses by Bacterial Zwitterionic Polysaccharides

The detection of pathogen-derived molecules as foreign particles by adaptive immune cells triggers T and B lymphocytes to mount protective cellular and humoral responses, respectively. Recent immunological advances elucidated that proteins and some lipids are the principle biological molecules that induce protective T cell responses during microbial infections. Polysaccharides are important components of microbial pathogens and many vaccines. However, research concerning the activation of the adaptive immune system by polysaccharides gained interest only recently. Traditionally, polysaccharides were considered to be T cell-independent antigens that did not directly activate T cells or induce protective immune responses. Here, we review several recent advances in “carbohydrate immunobiology”. A group of bacterial polysaccharides that are known as “zwitterionic polysaccharides (ZPSs)” were recently identified as potent immune modulators. The immunomodulatory effect of ZPSs required antigen processing and presentation by antigen presenting cells, the activation of CD4 T cells and subpopulations of CD8 T cells and the modulation of host cytokine responses. In this review, we also discuss the potential use of these unique immunomodulatory ZPSs in new vaccination strategies against chronic inflammatory conditions, autoimmunity, infectious diseases, allergies and asthmatic conditions.

Muscle spasm associated with therapeutic use of Cang Er Zi Wan

Introduction. Cang Er Zi Wan (CEZW) is a herbal medication derived from Xanthium sibiricum that is used to treat allergies and upper respiratory problems. Its toxicity has been described in grazing animals, in experimental studies, and in human overdoses. We describe a case of muscular spasm that was associated with the therapeutic use of CEZW. Case report. A 17-year-old female was prescribed CEZW for chronic allergies. Shortly after her second dose of 10 pills BID, she developed intermittent muscular spasms. She was seen in an Emergency Department and had normal vital signs and no significant laboratory abnormalities. Her physical exam was significant only for intermittent spasm of the muscles of the face, neck, and upper extremities. No tremor, fasciculation, dystonia, akisthisia, chorea, bradykinesia, or clonus was noted. She discontinued the CEZW and the symptoms slowly decreased over 4 days. Testing of the product did not detect any other medications or drugs. Discussion. CEZW is a herbal medication that contains X. sibiricum. X. sibiricum is a widespread weed that has caused muscular spasm, seizures, and death in animals that graze on it as well as animals experimentally exposed to it. Eleven cases of accidental human ingestion of Xanthium leading to spasm, somnolence, hypoglycemia, renal, and liver toxicity have been described. We describe a unique case of isolated muscular spasms because of the therapeutic use of a CEZW product.

The Added Burden of Comorbidity in Patients with Asthma

Objective. Compare the prevalence of comorbidities in adults with and without asthma in Canada and investigate the association between comorbidities in patients with asthma and the occurrence of asthma symptoms or attacks. Methods. Survey data from the 2005 Canadian Community Health Survey (CCHS) were analyzed. A total of 132,221 Canadians participated in the national survey; 10,089 adult respondents from 10 Canadian provinces and 3 territories reported having asthma. Analyses focused on 11 major chronic comorbidities. Results. Respondents with asthma were more likely to have comorbidities except cancer; 31% of respondents with asthma and comorbidities reported their health status to be fair or poor. For respondents with asthma, non-asthma chronic respiratory disease, mental illness, and allergy were significantly associated with having asthma symptoms or attacks. Conclusions. Many Canadians with asthma report a high comorbidity burden. These patients will likely require more health services and more complex health management strategies. Comorbid conditions should be clearly identified with particular emphasis on management of mood disorders and anxiety because these conditions are likely to increase asthma symptomatology and may be unrecognized by clinicians.