Elevated IgE Levels Research Articles

Major Immunogens Targeted by IgE During Helminth Infection

Much of our understanding of the targets of IgE comes from studies of allergy, though little is known about the natural immunogenic targets seen following parasitic worm infections. The use of human monoclonal antibodies (mAbs) allow for an unbiased, comprehensive characterization of the immunodominant antigens targeted by IgE in conditions (e.g., allergy, helminth infection) associated with elevated levels of IgE.

Airborne Pollen Reached Severe Levels During the Spring Season in an Underserved Community with High Asthma rates in Jacksonville Florida

Duval County, Florida is divided into 6 Health Zones. The most urban is Health Zone 1 (HZN1) of which 75% of its 109,314 residents are African Americans. It has the highest rate of asthma related hospitalization of the 6 health zones. During Spring 2013, we showed significant elevation of serum IgE from 200 random residents of the community of which 14% had levels greater than 10,000 ng/ml. Pollen inhalation is a risk factor for allergic conditions. Therefore, we hypothesized that pollen is a contributing factor for the elevated levels of IgE and the high rate of asthma in HZN1.

Is Posterior Nasal Nerve Neurectomy Really a Ray of Hope for the Patients of Allergic Rhinitis.

Allergic rhinitis significantly affects the quality of life, it contributes to missed or unproductive time at school or work, disturbed sleep pattern and day time somnolence. Rhinitis is defined clinically as having two or more symptoms of anterior or posterior rhinorrhoea, sneezing, nasal blockage and/or itching of the nose during two or more consecutive days for more than 1 h on most days (International rhinitis management working group, 1994). Allergic rhinitis is diagnosed when these symptoms are caused by allergen exposure leading to an IgE mediated reaction. Nerve irritation causes sneezing and itching, the loss of mucosal integrity causes causes rhinorrhoea and the vascular engrogment leads to nasal blockage. Medical modalities are symptomatically effective in mild cases, with temporary relief and addressable adverse effects. Prolonged treatment with allergy immunotherapy causes a sustainable financial burden while remaining inaccessible at smaller towns. Posterior nasal nerve neurectomy is short, easy and effective alternative. The basic procedure is to selectively cut nerve bundles at the level of the sphenopalatine foramen (SPF) with a trans nasal approach. By denervating the nasal mucosa one renders it unresponsive to any sorts of allergen or allergic reaction. The aim of the study was to evaluate the outcome of posterior nasal nerve neurectomy in cases of severe allergic rhinitis by assessing its impact on the total nasal symptom score. The study is a hospital based prospective study, conducted on 15 patients who presented to the ENT department of Mahatma Gandhi Hospital from march 2021 to October 2021 (6months) suffering from allergic rhinitis and did not show any satisfactory improvement even after 1year of medical treatment. Adult patients in the age group of 20-45 yrs. diagnosed with allergic rhinitis were enrolled into the study after obtaining a due written consent. These included patients having 2 or more symptoms of allergic rhinitis and refractoriness to medical therapy for > 1year along with significantly affected quality of life and elevated IgE level. Patients with drug induced & hormonal causes of rhinitis, chronic rhinosinusitis and any anatomical feature which precipitates to rhinitis such as deviated nasal septum, hypertrophied turbinates, blocked osteomeatal unit, polypoidal nasal mucosa and sinonasal polyposis were excluded from the study. During our study period from march 2021-September 2021, 15 patients were enrolled in the study. All the patients were followed up at 2nd and 6th month postoperatively. Amongst these patients, there were 11 females (73.34%) and 4 were male (26.67%)The mean age of patients was 35.2years. Subjective nasal symptoms of all 15 patients improved over the period of 6months. The mean TNSS improved from 12.067 preoperatively to 8.66 at the end of 2nd month, i.e., 23.1% improvement. By the end of the 6th postoperative month there was a consistent reduction in the tnss, which further reduced to a mean of 3.4 (70.2% reduction) indicating a further improvement in symptoms with time. With the advancement & popularity of endoscopic sinus surgery in the past decade, endoscopic resection of the posterior nasal nerve is emerging as a safe and less invasive technique with long standing results. Medical treatment usually provides mild and symptomatic relief with long duration of treatment period. Thus, PNN is safer, economical & easier alternative to current trend of treatment of allergic rhinitis, proving to be highly efficient in cases of intractable allergic rhinitis.

A Recalcitrant Case of Eosinophilic Pustular Folliculitis

Eosinophilic Pustular Folliculitis (EPF) or papulooerythroderma of Ofuji (PEO) is a rare dermatosis that presents with recurrent pruritic follicular papules and pustules that can involve the entire skin surface sparing the skin folds. This can be accompanied with elevated IgE levels and eosinophils. Diagnosis has been challenging due to its ability to mimic several common dermatologic disorders, such as acne and contact dermatitis. Literature has described the first line of therapy to be oral and topical indomethacin, however, success has been variable, and reports have been anecdotal. Until this day, there is yet to be standard guidelines for approach to diagnosis and management of this condition. In this article, we report a case of a 29 year-old female of Chinese descent who presented with papules on bilateral malar and nasal areas recalcitrant to topical corticosteroids. She demonstrated success with the use of a monthly regimen of isotretinoin after a perplexing diagnostic dilemma.

Відмінності в імунологічному статусі хворих на туберкульоз легень при розвитку алергічних та токсико-алергічних побічних реакцій при лікуванні протитуберкульозними препаратами

Abstract. The aim of the study: to establish differences in the immunological status of patients with pulmonary tuberculosis (TB) in the development of allergic and toxico-allergic adverse reactions during treatment with anti-tuberculosis drugs. Materials and methods of research. An analysis of the examination data of 68 patients with pulmonary TB who underwent inpatient treatment at the State Organization «Yanovsky National Institute of Phthisiology and Pulmonology NAMS of Ukraine». The mean age of patients was (38.2 ± 1.8) years (19 to 76 years). At the beginning of inpatient treatment in the clinic all patients underwent a complex examination: clinical, radiological, laboratory (general blood and urine tests, with blood levels of bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), urea, creatinine, glucose), microbiological, immunological (determination of serum tryptase level, total IgE level, lymphocyte migration inhibition (LMI) reaction and assessment of erythrocyte sedimentation rate (ERS) to first-line antitubercular drugs (ATD) (rifampicin, isoniazid and ethambutol)). Conclusions. The study revealed a significant difference between a number of immunological parameters in patients with pulmonary TB in the development of allergic and toxic-allergic reactions to ATD. The presence of clinical signs of allergy to ATD in patients with TB causes the formation of: elevated serum levels of tryptase and IgE, which indicates the activation of mast cells and basophils under the influence of ATD; significantly higher frequency of positive reactions of ERS (to isoniazid and ethambutol) and LMI (to isoniazid) — which reflects the state of sensitization to ATD. The immune status of patients with TB with allergic manifestations to ATD (without toxic reactions) differs from that in patients with toxic-allergic reactions with more pronounced laboratory signs of immediate hypersensitivity reactions to ATD. Immunological reactions in patients with TB with toxic-allergic reactions have a number of differences that are not typical for patients of group 1 with allergies: significantly lower lymphocyte sensitization in patients with ATD (only to isoniazid in LIM), lack of correlation of IgE serum levels with tryptase levels — indicating the genesis of other mechanisms of hypersensitivity to ATD (possibly pseudoallergic) in such patients. The formation of toxic-allergic manifestations of intolerance to ATD is influenced mainly by liver dysfunction, which indicates a leading toxic effect of ATD in such patients. Key words: allergic reactions, immunological parameters, cellular hypersensitivity, anti-tuberculosis drugs, toxic-allergic reactions, pulmonary tuberculosis

Association between exposure to chemical mixtures in relation to serum total IgE among adults 19–86 years old

There is a scarcity of studies on the effects of mixed chemicals on total IgE. We aim to assess whether there is a link between chemical mixtures (blood and urine of 26 chemicals including lead, mercury, cadmium, t,t-muconic acid, benzylmercapturic acid , 1-hydroxypyrene, 2-naphthol, 2-hydroxyfluorene, 1-hydroxyphenanthrene, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-n-butyl phthalate, mono-benzyl phthalate, mono-(2-ethyl-5-carboxypentyl) phthalate, mono-carboxyoctyl phthalate, mono-carboxy-isononly phthalate, mono (3-carboxypropyl) phthalate, bisphenol A, bisphenol F, bisphenol S, triclosan, methylparaben, ethylparaben, propylparaben, 3-phenoxybenzoic acid, and cotinine), and total IgE in 3,642 Korean adults aged ≥ 19. The effects of mixed chemical exposure on total IgE were identified using linear regression models, weighted quantile sum (WQS) regression, quantile g-computation (qgcomp), and Bayesian kernel machine regression (BKMR). The most relevant factors linked with IgE, according to the linear regression models, were blood or urine mercury and urine bisphenol A levels, with significant trends detected for these chemical tertiles (p < 0.01). The WQS index was significantly linked with ln2-transformed levels of serum total IgE (β = 0.30, 95 %CI 0.25–0.32). The qgcomp index also found a significant link between chemicals and ln2-transformed levels of serum total IgE (β = 0.52, 95 %CI 0.21–0.82), and elevated serum total IgE levels (OR = 2.55, 95 %CI 1.14–5.71). In BKMR analysis, the overall effect of the mixture was significantly associated with ln2-transformed levels of serum total IgE. The cutoff levels for exposure levels related to serum total IgE levels/elevated serum total IgE levels were reported. We discovered that whole-body exposure to 26 chemicals was associated with serum total IgE levels after assessing the findings of these four models. More research is needed in the future to gain a better understanding of the impact of mixed chemical exposure on allergic disorders and how to minimize chemical exposure, especially for people under the age of 18.

Rapidly progressive respiratory failure after helminth larvae ingestion

BackgroundSelf-administration of helminths has gained attention among patients as a potential but unproven therapy for autoimmune disease. We present a case of rapidly progressive respiratory failure in a patient with systemic sclerosis (SSc) and pulmonary arterial hypertension (PAH) as a result of self-administration of parasitic organisms.CaseA 45-year-old woman with a history of interstitial lung disease and PAH due to limited cutaneous SSc presented to pulmonary clinic with worsening dyspnea, cough, and new onset hypoxemia. Three months prior to presentation she started oral helminth therapy with Necator americanus as an alternative treatment for SSc. Laboratory evaluation revelaed eosinophilia and elevated IgE levels. IgG antibodies to Strongyloides were detected. High resolution computed tomography of the chest revealed progressive ILD and new diffuse ground glass opacities. Transthoracic echocardiogram and right heart catheterization illustrated worsening PAH and right heart failure. The patient was admitted to the hospital and emergently evaluated for lung transplantation but was not a candidate for transplantation due to comorbidities. Despite aggressive treatment for PAH and right heart failure, her respiratory status deteriorated, and the patient transitioned to comfort-focused care.ConclusionAlthough ingestion of helminths poses a risk of infection, helminth therapy has been investigated as a potential treatment for autoimmune diseases. In this case, self-prescribed helminth ingestion precipitated fatal acute worsening of lung inflammation, hypoxemia, and right heart dysfunction, highlighting the risk of experimental helminth therapy in patients, especially those with underlying respiratory disease.

Pilot study of dogs with suppurative and non-suppurative Malassezia otitis: A case series

BackgroundRarely, Malassezia otitis presents as a painful, erosive otitis with an otic discharge containing Malassezia and neutrophils on cytology. There are no published reports of this type of suppurative Malassezia otitis (SMO). The role of Malassezia hypersensitivity in otitis is still unknown, and no association has been demonstrated with SMO. We compared Malassezia IgE levels, intradermal test and histology changes in SMO dogs with the more conventional Malassezia otitis (MO) presentation.ResultsThree dogs (case 1, case 2 and case 3) were diagnosed with SMO, one dog (case 4) was diagnosed with unilateral MO and unilateral SMO, and one dog (case 5) was diagnosed with MO. Only one case (case 4) with SMO/MO had a positive Intradermal Allergy Test (IDAT) and elevated IgE levels for Malassezia. Histopathology findings from SMO revealed: interface dermatitis (case 1 and 3), lymphocytic dermatitis (case 2) and chronic hyperplastic eosinophilic and lymphoplasmacytic dermatitis (case 4). Histopathology findings from MO showed perivascular dermatitis (case 4 and 5). All the cases were treated successfully.ConclusionsSMO presents with a distinct clinical phenotype in comparison with conventional MO. No consistent aetiology could be isolated. In these clinical cases it is possible that previous treatments could have influenced the results. More research is needed to understand the possible aetiologies and the pathogenesis of SMO.

Heterogeneous origin of IgE in atopic dermatitis and psoriasis revealed by B cell receptor repertoire analysis.

Epicutaneous sensitization is an important route for the production of IgE, and skin inflammation-induced IgE has recently been reported having features of natural antibody. Atopic dermatitis (AD) and psoriasis have differentially increased level of serum IgE; however, the production mechanism of IgE in these inflammatory skin diseases remains unknown. To explore the origin of IgE in AD and psoriasis by analyzing the B cell receptor repertoire. mRNA was prepared from peripheral blood mononuclear cells of AD and psoriasis patients that had elevated serum levels of IgE, and immunoglobulin heavy chain (IGH) repertoires were sequenced after reverse transcription. Clonal lineages of B cells containing members expressing IgE were identified, and somatic hypermutations in IGH inherited from common ancestors within the clonal lineage were used to infer the relationships between B cells. The proportions of IGHE from AD and psoriasis were higher than that of normal control, which were positively correlated with the levels of serum total IgE. The somatic hypermutation value of IGHE variable region was lower than that of IGHG and IGHA, but higher than IGHM and IGHD, indicating a mixed natural and adaptive origins of IgE; and psoriasis demonstrated lower level of hypermutation than AD. The Shannon indexes of CDR3 in IGHE of AD and psoriasis were higher than that of normal control, also supporting the natural origin. The VH usage of IgE was weakly biased in AD and psoriasis patients with high level of house dust mite-specific IgE. Comparison of the number of shared mutations in multi-isotype lineages containing IgE showed that isotype-switching from IgG-expressing B cells might be the major source of IgE in AD and psoriasis. IgE has heterogeneous origin in AD and psoriasis, and skin inflammation may contribute to the increased production of natural IgE.

SOCS1 Haploinsufficiency Presenting As Incidental Refractory Thrombocytopenia in a Pediatric Patient with Inflammatory Symptoms and History of Sars Cov-2 Infection

BACKGROUNDImmune thrombocytopenia purpura (ITP) has a complex pathogenesis and may be a primary diagnosis or secondary to an underlying condition 1. Evaluation for underlying diagnoses in patients presenting with atypical features of classic ITP is key, as this can impact treatment decisions, therapy response, and prognosis. Genetic variants that predispose patients to ITP are especially important to investigate as patients may be at risk for additional autoimmune phenomenon or malignancy. The SARS CoV-2 pandemic has added further complexity as reports suggest the infection can lead to autoimmunity in those with genetic predispositions 2,3. Loss of the suppressor of cytokine signaling 1 (SOCS1) function has been described to manifest with autoinflammatory syndrome, with or without immunodeficiency 4,5. Reports of autoimmunity developing in patients with SOCS1 haploinsufficiency after SARS CoV-2 infection are documented, including multi-system inflammatory syndrome (MIS-C) 2. A proposed mechanism of this virus-triggered autoimmunity includes a transient innate and adaptive immunodeficiency 3. This raises the question whether patients harboring genetic variants with risk of autoimmunity are placed at an even higher risk for ITP in the wake of SARS-CoV2 infection. CASE PRESENTATIONWe present a 6-year-old female with isolated thrombocytopenia of 4,000/uL identified during evaluation for severe arthralgias unresponsive to corticosteroid treatment (maximum dose 1mg/kg/day) over a 6-month period. Laboratory results at presentation were consistent with ITP, including presence of platelet autoantibodies. Evaluation revealed hypocellularity for age (~50%) on bone marrow evaluation as well as elevated IgE (2080 kU/L), with IgA, IgM, and IgG levels within reference range. She had a remote history of SARS CoV-2-like illness and SARS CoV-2 antibodies were found present in serologic assay, without a history of vaccination. Genetic testing, including chromosomal microarray from peripheral blood and marrow, was included in the diagnostic workup given concern for a history of developmental delays with macrocephaly and necessity to rule-out malignancy with the patient noted to have a 5 mega-base deletion at 16p13.2p13.11, which includes the SOCS1 gene. Comprehensive next generation sequencing for additional immune dysregulation/primary immunodeficiency associated variants was unremarkable. Functional studies of surface expression of interferon-inducible genes (CD169 (SIGLEC-1)) and STAT1 phosphorylation via analysis of CD14+ monocytes revealed excess interferon signaling previously described in patients with SOCS1 haploinsufficiency (Figure 1). Measurements of B-cell-activating factor were also found to be extremely elevated at 6432 pg/mL. The patient's ITP course was complicated by hematuria, melena and refractory platelet response to first line therapy consisting of intravenous immunoglobulin 1 g/kg x2 doses and 2 mg/kg/day prednisolone. She required escalation to high dose methylprednisolone (30mg/kg), rituximab 375 mg/m 2/weekly x4 doses, and concurrent romiplostim (2 doses) for control of thrombocytopenia and bleeding manifestations. Her rheumatologic symptoms subsided with initiation of corticosteroids, and she has subsequently completed a prolonged corticosteroid taper. She currently has a normal platelet count with non-steroidal anti-inflammatory therapy utilized for arthralgia management with plan to transition to JAK inhibition for maintenance therapy. CONCLUSIONThis case highlights the potential impact of investigating for susceptibility genes for ITP with consideration for broader testing including targeted next generation sequencing panels or microarray analysis in patients with atypical ITP presentations or response to therapy, as knowledge of this patient's underlying genetics led to earlier treatment and use of alternative agents. Additionally, the case adds the novel finding of bone marrow hypocellularity to the clinical phenotype of SOCS1 haploinsufficiency, as this has not yet been reported and contributes to the literature on the relationship of autoimmunity and SARS CoV-2 infections in patients with predisposing genetic variants. [Display omitted] DisclosuresWalkovich: Horizon Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pharming: Honoraria, Membership on an entity's Board of Directors or advisory committees; Swedish Orphan Biovitrum AB (Sobi): Consultancy, Honoraria; X4 Pharmaceuticals: Other: Local PI for clinical trial involving mavorixafor and patients with neutropenia.

Environmental allergens house dust mite-induced asthma is associated with ferroptosis in the lungs.

Previous studies have indicated that allergens such as house dust mites (HDM) in the environment can induce allergic asthma. Ferroptosis is a newly discovered form of regulatory cell death characterized by aberrant lipid peroxidation and the accumulation of reactive oxygen species (ROS) in cells. However, whether ferroptosis participates in the pathological process of asthma remains to be elucidated. The present study used a HDM-induced mouse asthma model to determine the effect of HDM exposure on allergic asthma and its underlying mechanisms. Female BALB/c mice were intranasally exposed to HDM to induce allergic asthma. Airway hyperresponsiveness (AHR), lung inflammation, mucus secretion, IgE levels, cytokine levels and inflammatory cell counts in bronchoalveolar lavage fluid (BALF) were investigated. In addition, the morphological changes of mitochondria, ROS levels, glutathione (GSH) levels and changes in ferroptosis pathway proteins were also determined in murine lungs. As a result, HDM exposure significantly increased AHR, inflammatory cell infiltration and mucus secretion around the airways. Furthermore, elevated IgE levels in the BALF, lung eosinophilia and a concomitant increase in IL-13 and IL-5 levels in BALF were observed. HDM inhalation increased ROS and decreased GSH levels in the lungs. HDM inhalation induced dysmorphic small mitochondria with decreased crista, as well as condensed, ruptured outer membranes. Western blotting demonstrated that the activities of glutathione peroxidase 4 and catalytic subunit solute carrier family 7 member 11 were significantly decreased, and that protein expression levels of acyl-CoA synthetase long-chain family member 4 and 15 lipoxygenase 1 were upregulated compared with mice in the normal control group. Overall, these results indicated that the AHR, airway inflammation, lipid peroxidation and ROS levels increased in HDM-induced asthma, and that HDM inhalation induced ferroptosis in the lungs, which helped to form an improved understanding of the pathogenesis of allergic asthma.

Association of celiac disease with eosophageal eosinophilia and eosinophilic eosophagitis

Aim of the study was to evaluate the association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia in children. A total of 278 patients with celiac disease (mean age: 7.12±4.64years, M/F: 0.77) were involved in the study. The patients were evaluated retrospectively in terms of clinical, endoscopic and histopathological findings. The association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia was determined. According to Marsh classification system 6 (2.1%) of the patients were graded type 3A, 10 (3.5%) were type 3B, 262 (94.4%) were type 3C. The histopathological examination of oesophageal biopsy specimens of the patients revealed <15 eosinophils per high power field in only 4 (1.4%) patients. Two of these patients were positive for HLA DQ8, one was DQ2, and the other one was both DQ8 and DQ2. Tissue transglutaminase IgA level was above 300U/mL in these patients. None of them had elevated serum total IgE levels, peripheral eosinophilia and history of atopic diseases. The gastrointestinal symptoms resolved and tissue transglutaminase IgA level of the patients were declined after 3months of gluten-free diet. Although an association between celiac disease and eosinophilic oesophagitis/oesophageal eosinophilia have been postulated in recent years, no exact relationship was established in this study. This is the first study reporting the performance of follow-up GI endoscopy with biopsies revealing the resolution of oesophageal eosinophilia.

Dupilumab-induced ocular surface disease: A systematic review

Dupilumab-induced ocular surface disease: A systematic review

Racial/ethnic differences in eligibility for asthma biologics among pediatric populations

Asthma is a heterogeneous disease. Clinical blood parameters differ by race/ethnicity and are used to distinguish asthma subtypes and inform therapies. Differences in subtypes may explain population-specific trends in asthma outcomes. However, these differences in racial/ethnic minority pediatric populations are unclear. We investigated the association of blood parameters and asthma subtypes with asthma outcomes and examined population-specific eligibility for biologic therapies in minority pediatric populations. Using data from 2 asthma case-control studies of pediatric minority populations, we performed case-control (N= 3738) and case-only (N= 2743) logistic regressions to quantify the association of blood parameters and asthma subtypes with asthma outcomes. Heterogeneity of these associations was tested using an interaction term between race/ethnicity and each exposure. Differences in therapeutic eligibility were investigated using chi-square tests. Race/ethnicity modified the association between total IgE and asthma exacerbations. Elevated IgE level was associated with worse asthma outcomes in Puerto Ricans. Allergic asthma was associated with worse outcomes in Mexican Americans, whereas eosinophilic asthma was associated with worse outcomes in Puerto Ricans. Alower proportion of Puerto Ricans met dosing criteria for allergic asthma-directed biologic therapy than other groups. Ahigher proportion of Puerto Ricans qualified for eosinophilic asthma-directed biologic therapy than African Americans. We found population-specific associations between blood parameters and asthma subtypes with asthma outcomes. Our findings suggest that eligibility for asthma biologic therapies differs across pediatric racial/ethnic populations. These findings call for more studies in diverse populations for equitable treatment of minority patients with asthma.

The clinical efficacy and safety of anti-IgE therapy inrecessivedystrophic epidermolysis bullosa.

The treatment of recessive dystrophic epidermolysis bullosa (RDEB) remains challenging. Elevated IgE levels have previously been reported in several RDEB patients. In this prospective, single-centre, open intervention study, elevated IgE levels were seen in 11 out of 12 patients with intense pruritus, and the patients with elevated IgE levels received anti-IgE therapy every 4 weeks for at least three cycles. Compared with the baseline, 10 patients with RDEB had good clinical outcomes with enhanced wound healing, a reduction in Birmingham (epidermolysis bullosa) EB severity score by 15%, a reduction in affected body surface area by 23.3%, amelioration of skin inflammation, and an increase in type VII collagen deposition by 13.1-fold. All the patients had a good tolerance to anti-IgE therapy. Furthermore, patients with higher IgE levels tended to have higher disease severity and more favorable clinical outcomes. Our report also suggested the potential role of IgE in the pathogenesis of inflammatory conditions associated with RDEB. (ChiCTR1900021437).

Частота функциональных расстройств билиарного тракта у детей с атопическим дерматитом

Актуальность. Как отмечают многие авторы, тяжесть течения и выраженность атопического дерматита (АД) во многом зависят от функционального состояния органов пищеварения. Цель: исследовать частоту и проанализировать особенности течения атопического дерматита у детей с нарушениями билиарной системы. Материалы и методы. Обследовано 168 детей в возрасте от 1 до 18 лет с АД. Диагноз АД у детей выставляли согласно диагностическим критериям J.M. Hanifin и G. Rajka (1980). Все пациенты и их родители были анкетированы с использованием карты обследования. Изучали общий и специфические IgE (педиатрическая панель). Состояние билиарной системы изучали с помощью ультрасонографии, биохимических показателей сыворотки крови. Статистическая обработка результатов исследований осуществлялась с помощью стандартных алгоритмов вариационной статистики. Результаты. По данным анкетирования выявлены следующие факторы риска развития АД у детей и подростков: наследственность (53,5 %), проявления аллергии на первом году жизни (62,5 %), высокие уровни IgЕ (52,3 %); факторы, способствующие обострению АД (триггеры): смешанные аллергены — 23,8 %, пищевые аллергены — 71,4 %, лекарственные аллергены — 17,8 %, бытовые аллергены — 5,9 %, пыльцевые аллергены — 3,4 %, температурный фактор — 1,7 %, психоэмоциональный фактор — 1,7 %, неустановленные — 24,6 %; искусственное вскармливание с рождения (13,1 %); общая продолжительность манифестации АД: до года — 11,3 %, от 1 до 5 лет — 44,9 %, от 5 до 10 лет — 23,8 %, более 10 лет — 20,3 %. Среднее значение по шкале SCORAD у пациентов с легкой степенью АД составило 14,01 ± 0,63 балла, со средней степенью АД — 31,04 ± 0,92 балла, у пациентов с тяжелой степенью — 56,17 ± 5,23 балла. Средний балл по шкале EASI у обследованных пациентов в возрасте от 5 до 7 лет составил 8,67 ± 0,46. Повышенный уровень IgE отмечался у 52,3 % детей. При активном опросе и осмотре признаки функционального расстройства билиарного тракта обнаружены у большинства пациентов — 109 (64,8 ± 3,2 %) детей. При УЗИ у 45 (42,8 %) из 109 детей, которые имели жалобы, установлена дисфункция желчного пузыря. Увеличение размеров печени (до 10 %) без изменения эхоструктуры и эхогенность наблюдалось у 26 (23,8 ± 0,8 %) детей с АД. Выводы. С учетом высокой частоты функциональных нарушений билиарного тракта детям с АД целесообразно проводить ультразвуковое исследование органов пищеварительной системы. На основе полученных данных важно проводить соответствующую коррекцию выявленных нарушений в комплексном лечении АД.

Association between environmental exposure to phthalates and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) 2015-2017.

Phthalates are common industrial chemicals that are used as plasticizers in plastics, personal care products, and building materials. Although these chemicals have been suspected as risk factors for allergic outcomes among children, inconsistent associations between environmental exposure to phthalates and allergic disorders have been found across different populations. Therefore, this study aimed to assess whether environmental phthalate exposure was associated with parent-reported current allergic symptoms (atopic dermatitis, AD; asthma; and allergic rhinitis, AR) and the index of allergic response (levels of serum total immunoglobulin E, IgE) in a nationally representative sample of children. In this study, children aged 3-17 years (n=2208) were recruited from the Korean National Environmental Health Survey (KoNEHS) 2015-2017 to conduct an analysis of their current allergic symptoms. Among this number of children, the total IgE analysis included 806 participants because total IgE levels were only measured in children aged 12-17 years. After adjusting for all covariates, mono-benzyl phthalate (MBzP) [OR (95% CI)=1.15 (1.01, 1.30)], mono-(carboxyoctyl) phthalate (MCOP) [OR (95% CI)=1.35 (1.02, 1.78)], and the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) [OR (95% CI)=1.39 (1.09, 1.79)] were associated with increased odds of current AD. MCOP [OR (95% CI)=1.19 (1.01, 1.40)], mono-(carboxynonyl) phthalate (MCNP) [OR (95% CI)=1.24 (1.05, 1.45)], and ∑DEHP [OR (95% CI)=1.22 (1.02, 1.44)] were also associated with increased odds of current AR. Individual DEHP metabolites showed similar associations with current AD and AR. In addition, MCNP was positively related to IgE levels [β (95% CI)=0.26 (0.12, 0.40)]. MBzP [OR (95% CI)=1.17 (1.01, 1.35)], MCOP [OR (95% CI)=1.62 (1.12, 2.32)], and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) [OR (95% CI)=1.36 (1.06, 1.76)] showed positive relationships with allergic multimorbidity. Moreover, higher concentrations of MCNP were related to increased odds of experiencing both current AR and total IgE levels [OR (95% CI)=1.98 (1.29, 3.04)], and children with elevated IgE levels (>100IU/mL) were more likely to have current AR associated with MCNP than those without elevated IgE levels (p=0.007). Specifically, the relationship between MCNP and current AR was significantly mediated through alterations in IgE levels (14.7%), and MCNP also showed the positive association with current AR, independent of IgE (85.3%). These results suggest that environmental exposure to phthalates may affect the immune system and increase the occurrence of allergic symptoms in children.

BCG for the prevention and treatment of allergic asthma

Allergic diseases, in particular atopic asthma, have been on the rise in most industrialized countries for several decades now. Allergic asthma is characterized by airway narrowing, bronchial hyperresponsiveness, excessive airway mucus production, eosinophil influx in the lungs and an imbalance of the Th1/Th2 responses, including elevated IgE levels. Most available interventions provide only short-term relief from disease symptoms and do not alter the underlying immune imbalance. A number of studies, mostly in mouse models, have shown that Mycobacterium bovis bacillus Calmette-Guérin (BCG) treatment is capable of preventing or reducing an established allergen-driven inflammatory response, by redirecting pathogenic Th2 towards protective Th1 and/or regulatory T cell responses. Dendritic cells stimulated by BCG appear to be a crucial first step in the immunomodulatory effects of BCG. While the protective and therapeutic effects of BCG against allergy and asthma are well documented in animal models, they are less clear in humans, both in observational studies and in randomized controlled trials. The purpose of this article is to provide an up-to-date overview of the available evidence on the anti-allergy, in particular anti-asthma effects of BCG in mice, rats and humans.

Development and preclinical evaluation of a vaccine targeting IL-4 and IL-13 for the treatment of allergic asthma.

Asthma is the most prevalent chronic respiratory disease, affecting more than 300 million people worldwide1 . Although asthma is a heterogenous disease that presents with various phenotypes, around 50 % of the patients suffer from type 2 inflammation, characterized by elevated levels of IgE, type 2 cytokines such as IL-4 and IL-13 and eosinophilia1 .

Treatment of severe atopic dermatitis and eosinophilic esophagitis with dupilumab in a 14-year-old boy with autosomal dominant hyper-IgE syndrome

Autosomal dominant hyper-IgE syndrome (AD-HIES), also known as Job syndrome and Buckley syndrome, is characterized by elevated IgE levels, eosinophilia, recurrent cutaneous and internal organ abscesses, pneumonia leading to pneumatoceles, mucocutaneous candidiasis, characteristic facies, delayed shedding of primary teeth, bone fractures due to minor trauma, joint hypermobility, and scoliosis.1 In addition, allergic disorders such as atopic dermatitis (AD), food allergy, and eosinophilic esophagitis (EoE)2 may be associated with AD-HIES.