Chronic Atopic Disease Research Articles

Th2 Cells: Orchestrating Barrier Immunity

Publisher Summary This chapter summarizes recent insights regarding the generation of T helper (Th) 2 cells and factors regulating expression of IL-4—the canonical cytokine secreted by these cells. Th2 cells orchestrate a stereotyped cell response characterized by eosinophil and basophil infiltration, mast cell hyperplasia, and changes in epithelial mucus and water secretion. Th2 cells have been demonstrated to mediate protection against not only a variety of intestinal helminthes but also ectoparasites that invade at epithelial barriers. When activated systemically, Th2 cells protect against the tissue-damaging proinflammatory actions of Th1 cells. When dysregulated, Th2 cells drive chronic atopic diseases of wide prevalence such as allergy and asthma. Basic insights into the understanding of the generation, activation, tissue localization, and turnover of Th2 cells will provide numerous opportunities for sustained benefits to human health.

Latest Developments in the Management of Allergic Rhinitis

Allergic rhinitis (AR) is the most common chronic atopic disease, and it is associated with considerable costs and comorbidities. The management of AR includes environmental control measures, pharmacotherapy, and immunotherapy. This article discusses several developments and findings that have recently emerged in these three areas. The effectiveness of traditional methods of mitigating allergen exposure, such as the use of impermeable dust mite-proof bedding covers, has been rendered debatable. Exposure to environmental factors, such as household pets, is known to provoke exacerbation of allergic disease but now is proposed to have protective effects in certain settings. Changes in the choices of pharmacotherapy continue to occur as antileukotrienes and derivatives of certain antihistamines are added to the armamentarium against AR. However, a critical review of the clinical trials involving these drugs suggests that the changes are not necessarily incremental. Innovative methods of immunomodulation are currently being developed, with the objective of optimizing efficacy and safety. These include alternative routes or forms of delivering immunotherapy and other novel approaches in altering the pathobiology of AR.

High rates of autoimmune and endocrine disorders, fibromyalgia, chronic fatigue syndrome and atopic diseases among women with endometriosis: a survey analysis.

Women with endometriosis may also have associated disorders related to autoimmune dysregulation or pain. This study examined whether the prevalence of autoimmune, chronic pain and fatigue and atopic disorders is higher in women with endometriosis than in the general female population. A cross-sectional survey was conducted in 1998 by the Endometriosis Association of 3680 USA members with surgically diagnosed endometriosis. Almost all responders had pain (99%), and many reported infertility (41%). Compared with published rates in the general USA female population, women with endometriosis had higher rates of hypothyroidism (9.6 versus 1.5%, P < 0.0001), fibromyalgia (5.9 versus 3.4%, P < 0.0001), chronic fatigue syndrome (4.6 versus 0.03%, P < 0.0001), rheumatoid arthritis (1.8 versus 1.2%, P = 0.001), systemic lupus erythematosus (0.8 versus 0.04%, P < 0.0001), Sjögren's syndrome (0.6 versus 0.03%, P < 0.0001) and multiple sclerosis (0.5 versus 0.07%, P < 0.0001), but not hyperthyroidism or diabetes. Allergies and asthma were more common among women with endometriosis alone (61%, P < 0.001 and 12%, P < 0.001 respectively) and highest in those with fibromyalgia or chronic fatigue syndrome (88%, P < 0.001 and 25%, P < 0.001 respectively) than in the USA female population (18%, P < 0.001 and 5%, P < 0.001 respectively). Hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.

Art therapy and chronic illness: An enquiry into aspects of service provision for patients with atopic skin disease

This article aims to establish the views of service providers on the potential of art therapy as an addition to treatment provision of chronic atopic skin disease. It uses data from a questionnaire survey delivered in one health board area in Scotland. The questionnaire was designed to identify current services available; patterns of prescribing; and to determine the range of views, beliefs and attitudes held by service providers. The results confirm that the target groups do not prescribe art therapy within their health board area and there is little interest in art therapy as a treatment option. Most respondents were unable to comment on whether there may be benefit for this patient group in either self-expression through art or treatment in art therapy. This seems to suggest that there are major issues for the profession in Scotland with regard to how art therapy is perceived and the lack of provision and appreciation of the potential value of art therapy. Descriptive material indicates a wide range of beliefs and attitudes relating to the psychological impact of chronic atopic skin disease. However, a statistically significant number of respondents perceived that higher numbers of patients do experience psychological problems and that their needs are not being met by current service provision.

The impact of childhood food allergy on quality of life

Food allergy affects >6% of children, but the impact of this disease on health-related quality of life has not been well studied. Parental perceptions of physical and psychosocial functioning were measured with the Children's Health Questionnaire (CHQ-PF50). This tool and an additional allergy-related questionnaire were sent to 400 members of the Food Allergy and Anaphylaxis Network with children aged 5 to 18, an age group on which the tool has been validated. Surveys were completed by 253 parents (63%). The mean age of the food-allergic children was 10.8 years (range, 5 to 18 yrs); 59% were male. Sixty-eight percent were allergic to one or two foods, the remainder to more than two foods. Concomitant chronic atopic diseases included: asthma with atopic dermatitis (33%), atopic dermatitis alone (13%), asthma alone (33%), and 21% had neither asthma nor atopic dermatitis. In comparison to previously established norms, the families scored significantly lower (more than 10 scale score points lower and P < 0.0001) for general health perception (GH), emotional impact on the parent (PE), and limitation on family activities (FA). Associated atopic disease, influenced primarily by those with both asthma and atopic dermatitis, accounted for a significant reduction in the GH scale (analysis of variance, P = 0.0001), but not for measures of PE and FA. Within the study group, food-allergic individuals with several (more than two) food allergies had significantly lower (P < 0.05) scores for 7 of 12 scales compared with individuals with few (one or two) food allergies. However, those with one or two food allergies scored significantly lower (P < 0.0001) than established norms on scales for GH, PE, and FA. Childhood food allergy has a significant impact on GH, PE, and FA. Factors that influence reductions in these scales include associated atopic disease and the number of foods being avoided.

IgE–Mediated Reactions to Autoantigens in Allergic Diseases

Background: There is increasing evidence that IgE–mediated reactivity against autoantigens could play a role in the pathology of severe chronic atopic diseases. Methods: Human mitochondrial managenese superoxide dismutase (MnSOD), acidic ribosomal P₂ protein and cyclophilins were cloned by PCR, expressed as inclusion body proteins in Escherichia coli, purified by Ni²⁺–chelate affinity chromatography, refolded in vitro and used for further experiments. Results: Human MnSOD, P₂ ribosomal protein and cyclophilins respectively, show sequence identity and similarity of >50% and 70% to the corresponding allergens of Aspergillus fumigatus. The human proteins were able to bind IgE from sera of individuals sensitized to the mould proteins and to elicit strong skin reactions of the immediate type in these individuals. Conclusions: These observations provide evidence for autoreactivity to human proteins in allergic persons chronically sensitized to environmental allergens from A. fumigatus which share a high degree of sequence homology to the corresponding human proteins.

Utilization of Personal Protective Equipment by Laboratory Personnel at a Large Medical Research Institution

Abstract The federal Guide for the Care and Use of Laboratory Animals (1985) recognizes allergy to laboratory animals (ALA) as an occupational hazard and calls for the development of methods for its prevention. The prevalence of symptomatic ALA (rhinitis and/or urticaria) ranges from 15–33 percent, and its costs include not only the medical consequences of chronic atopic disease but also the loss of highly trained personnel. Employers at many laboratory animal facilities provide personal protective equipment (PPE) as a preventive measure to reduce the risk of ALA. A survey of the use of PPE by a sample of laboratory animal personnel at a large medical research institution is reported here. During the week surveyed, 171/210 persons (81%) did not use any respiratory PPE (e.g., respiratory masks), indeed, 61/210 (29%) did not use any PPE whatsoever. Failure to use any PPE was related to the type of animal(s) to which the staff was exposed and to the work task performed, as well as certain demographic factors, educational achievement, and job title. Traditional industrial hygiene approaches to control the concentration of laboratory animal allergen in the air should be evaluated, particularly engineering controls.